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01/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Medicaid Change for Orthotics in NY
From: Alan Silverstein, DPM
Has any other New York podiatrist noticed that this past Oct. 1, New York’s Medicaid program made a change that negatively affects podiatrists? Under the old program, Medicaid recipients in many of the various managed care plans were eligible, when medically necessary, to receive orthotics directly from participating podiatrists in the plans. Under the new program, only an “approved vendor” can now supply the orthotic. The podiatrist can make the referral with a prescription, but they cannot supply the item directly. Several of the managed care plans have told me that they do not permit their participating podiatrists to be “vendors.” Besides the loss of income, there is the loss of our expertise to these patients, as these devices are usually not biomechanically functional.
Alan Silverstein, DPM, NY, NY, alel@optonline.net
Other messages in this thread:
12/17/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: Efficacy of "Pain" Creams (Tip Sullivan, DPM)
From: Howard Dananberg, DPM, John F. Swaim, DPM)
I never used “pain creams” in practice. That was until I was introduced to Motion Medicine™ while lecturing in Canada over two years ago. I was so impressed as to how effective this was that I became the U.S. importer.
Motion Medicine™ uses an array of ingredients which act for pain relief as well as a significant anti-inflammatory effect. It contains glucosamine and chondroitin to help restore joint cartilage. It contains thymol, which in small amounts, acts as a local anesthetic. MSM and sea cucumber works to reduce inflammation and support healing.
Disclaimer: I am the owner of Motion Medicine, LLC in the U.S.
Howard Danneberg, DPM, Stowe, Vt, hdananberg@gmail.com
I too became frustrated early in my career over the lack of a reasonable alternative for my patients with painful neuropathy who did not gain benefit from Neurontin and its sister medications. If you read the labels, most all of these rely mostly on the effects of menthol. The only alternative at the time was to have the local compounding pharmacy make and dispense a 2 oz jar containing a mixture of clonidine, lidocaine, and ketamine; and it cost $70 out-of-pocket and worked about 33% of the time.
My frustration with this void in treatment options for symptomatic neuropathy led me into extensive research and the development of...
Editor's note: Dr. Swaim's extended-length letter can be read here.
05/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Is it Time to Bring Back Chiropody?
From: H. David Gottlieb, DPM
An ongoing thread on sterilization shows the split personality of podiatry. The skill with which we have historically eased the pains of humanity's feet is the foundation upon which all our advances have come. Many practitioners still provide valuable services to those who are otherwise unwilling or unable to have surgery using time-tested methods often passed down one to one. These skillful hands can ease discomfort and restore the ability to walk without cutting skin, just by using felt.
Residency training now is surgically geared with a secondary emphasis on biomechanics, but none to little on the old 'c and c' ['corns and calluses' or 'chipping and clipping']. I am actually fine with this. Personally, I found the old practice style to be...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
03/17/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: ABPS Name Change (M. W. Aiken, DPM)
From: David McKenzie, DPM, PGY-2
As new foot and ankle surgeons nearing completion of our training and entering our specialty, we have been observing the changes in our profession and specialty. Much has occurred and continues to occur which gives us cause for optimism. We are enthusiastic about the possible name change of our surgical certification organization.
We believe this is a major step forward in our identification and recognition, which allows us a clear statement of what we are training for and what we hope to...
Editor's note: Dr. McKenzie's extended-length letter can be read here.
03/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatry Chairs (Robert Lagman, DPM)
From: Richard Rettig, DPM
I have had a Hill chair for about 15 years and it has held up nicely. I had a boatload of little aggravations with it, based on poor design choices, and I had to work with the company to get the chair to be serviceable. I wrote a letter to the company at the time, stating that all these changes should be made permanent, as they would be needed to meet the needs of a typical podiatrist. Sadly, I believe they ignored all my suggestions.
When another DPM recommended the chair to me, he said he bought an 'oversized' foot cushion. I didn't see any need for 'oversize', so I got the regular size. I found out in a matter of days that it was perfectly suited if your typical patient is 5 foot tall, and your tallest patient is 5'8". I had to have them remake it "oversized" to be useable. All the hand switches were poorly placed, and I had them move or change all of them. I was disappointed that the company had so little regard for getting it right the first time.
Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com
02/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Eric Roberts, DPM)
From: Daniel. J. Tucker, DPM, Leonard A. Levy, DPM
I completely agree with Dr. Roberts. His commentary summarizes exactly the attitude that we as podiatric physicians and foot and ankle surgeons need to perpetuate in order to remain an integral part of the healthcare community. The nomenclature attached to our medical degrees and post-graduate training programs reflects the progression that we as a profession have made in past decades. It's time for our professional titles to catch up as well.
Daniel. J. Tucker, DPM, Atlanta, GA, reekat@aol.com
For most of the history of medicine, the term “physician” referred to someone who treated the whole body. According to practice acts in every state, MDs and DOs are licensed as physicians and surgeons. But that is an overstatement, certainly far from being true, not in the best interest of the public, and an anachronism. For example, psychiatrists and radiologists are licensed physicians and surgeons. But if these highly qualified physicians did any surgery, they would be targets of massive malpractice actions. DPMs independently diagnose, prescribe drugs, order laboratory tests, perform invasive surgery, and treat fractures.
That is certainly the practice of medicine regardless of what the law may state. Laws in some states prohibit us from saying we are physicians, but because of what we do, we are physicians. Such laws will continue and remain a dinosaur until and unless we engage with vigor in changing them. No one will do that for us.
Leonard A. Levy, DPM, Ft. Lauderdale, FL, levyleon@nova.edu
01/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Bone Mineral Density Testing (Elliot Udell, DPM)
From: Sloan Gordon, DPM
My point was that, as specialists, we have the education, ability, and obligation to treat those disorders for which we were trained. It is also my opinion that DPMs should be reimbursed for the procedures we perform. I was not suggesting that one test vs. another was more accurate. It's unfortunate that Dr. Udell refers everything out. So what is left for him to treat?
I simply stated there are other tests which previous writers did not acknowledge, and which DPMs can perform. Is there a problem doing non-invasive vascular testing in the office when others read the results? If there is, many internists in my town must not be following Dr. Udell's dogma. There are always those narrow-minded professionals who are in self-denial vis-a-vis their own abilities. That's unfortunate, and again highlights my suggestion that we are often our own worst enemies. It's the "if I can't do it, neither should you" mentality. Don't we have enough people making us look bad? Do our own colleagues feel the need to encourage them?
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
12/22/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Starting a Practice (Michael Rosenblatt, Peter Harvey, DPM)
From: Jeffrey Kass, DPM, Peter Smith, DPM
I echo the comments of Drs. Rosenblatt and Harvey. I was laughing when reading Dr. Harvey's post - his greatest tip came from Bob Levoy. I learned that tip back in first grade. It was actually G-d who needs to be credited, as we are taught HE rested on Saturday.
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com
I am intrigued by Dr. Harvey’s comment about not working on Saturdays. What is the rationale behind that? Currently, I work a short day on Saturday (8:00 – 11:00AM). If you can give me a compelling reason, I would gladly give it up!
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu
11/28/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: The Blood Pressure Discussion (Randall Brower, DPM)
From: Daniel Chaskin, DPM
A machine at Walgreens does not make up for the skill of a podiatrist or a physician actually listening to the blood pressure. If you diagnose high blood pressure, why not also refer out to a cardiologist or PCP? Being a podiatrist is a profession in which you can help patients. Isn't this what we are in practice for?
Daniel Chaskin, DPM, Ridgewood, NY, podiatrist12@verizon.net
11/10/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Service to Determine Deductibles and Co-Pays? (Chuck Ross, DPM)
From: Eric Trattner, DPM, William Tenney, DPM
After seeing this posting regarding the billing of higher deductibles and co-payments, I wanted to let everyone know what we are doing in our practice with significant positive results. Four years ago, in an effort to share resources, several of us got together and started a company called IVS. This company specializes in the verification of insurance coverage and benefits levels.
Over the past several years, by using IVS, we have seen our accounts receivables reduced from many thousands of dollars to a fraction of that number. The need for patient billing has also decreased dramatically. We generally have all the information regarding eligibility, deductibles, and co-payment amounts, as well as coverage for durable medical equipment by the initial patient visit. This allows our front desk staff to collect the appropriate amount from patients before they are put into the treatment room. It has been the single most productive and cost-effective practice management tool we have utilized in over 20 years of practice.
Eric Trattner, DPM, William Tenney, DPM, Fairview Park, OH, etrattner@att.net
09/30/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Social Media Policy (James E. Rogers, DPM
From: Kevin Lam, DPM
Dr. Rogers brings up a point that has become a boiling point in my office too: social media, personal texting, personal emailing, Facebook, Twitter, etc. All distract and take away from the work to be done in the office. I had to put policies in recently, as not only my medical staff but also my doctors have been abusing the systems of texting, Facebook, etc.
It is distracting at work when they become "FRIENDS" on Facebook, and the doctor/staff relationship becomes a problem. How does this become a problem? They start sharing personal information, sharing weekend adventures and photos, information that they would otherwise not share. Schools here have disallowed teachers and students from being "friends" for the same reason. It became a problem of polarizing our office. I started with no Facebook during working hours. Well, that didn't work. Now it's NO Social media or personal text at all in the office. This new policy was one of the reasons to have to dismiss a couple of doctors and a couple of their "FRIENDS" for violations. It is a very slippery slope that should not be allowed.
Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com
09/10/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Kudos for the Open Forum
From: Matthew B. Richins, DPM
It is clear that Dr. Block is strongly for the changing our degree to add MD or DO. I respectfully disagree. However, the purpose of writing is to thank PM News for publishing the other side of the argument, dispite Dr. Block's personal feelings. I wish all media outlets had that kind of journalistic integrity. Keep up the good work.
Matthew B. Richins, DPM, Joplin, MO, mnmrichins@yahoo.com
08/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: CROW Walkers (Jay Kerner, DPM)
From: Susan Bartos
Earthwalk Orthotics has partnered with TruLife for its braces and AFOs. TruLife is a global manufacturer of orthopedic and physical rehabilitation products. All of their podiatric braces are fabricated in the facility formally known as Seattle Systems. We have received very positive feedback from our DPMs who have ordered CROW walkers through Earthwalk, via TruLife. A knee-high, STS, fiberglass, casting sock is simple to apply, and works very well for casting for a CROW walker.
Susan Bartos, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com
08/18/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Legality of Maximalist Running Shoes (Robert Bijak, DPM)
From: Brian Kiel, DPM
After looking at the Hoka shoes on their web-site, there is no way I could recommend or use that shoe. First of all, it is very similar to the MBT shoes. There is little to no flexibility, and anyone running on a regular basis will put a great deal of stress on the anterior of the ankle and lower leg, probably leading to shin splints; and with the lack of flexibility, strain on the plantar fascia. Secondly, it appears to be a straight-last shoe which is okay if you need a great deal of medial stability, but for any other type of foot, it is contraindicated. Just like the minimalist shoes, this one is probably eventually doomed to the extinct shoe hall of fame.
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
07/07/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: How Would Your Life be Different if You Had an MD Degree (Art Korbel, DPM, MD)
From: B.T. Sullivan, MS, DPM
I am a strong advocate for a degree change - mostly for those reasons stated by Dr. Korbel.
The fact that he has developed acceptance in his medical community by "degree" is a good reason to change our degree. For those of us who have developed acceptance in our medical communities, it has taken many years of proving ourselves on a daily basis and years of interaction for the other physicians in our areas to feel comfortable with us and our abilities. The doctors graduating our residency programs should not have to go through that. Our programs should have uniformity and standardization. Our leaders should push us hard in that direction!
The real question that I have for Dr. Korbel is:...
Editor's note: Dr. Sullivan's extended-length letter can be read here.
04/21/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Simon Young, DPM, Kenneth Meisler, DPM
If Dr. Sullivan or any surgeon thinks that they need a bone stimulator post-operatively, then the procedure should never be done! The only potential reason for post-op use of a bone stimulator, in my opinion, would be in Charcot foot reconstruction, Jones fracture, or repair of a non-union.
Simon Young, DPM, NY, NY, simonyoung@juno.com
Dr. Sullivan said that he is thinking of using a bone stimulator on all osteotomies, even low risk ones to get people walking more quickly. It is a waste of healthcare dollars to use a bone healing system on low risk osteotomies. I use them only on cases such as Jones Fractures, with or without ORIF, because of their high risk of non-union. I also would consider using one on a Lapidus where you do not feel you had "perfect" fixation, or perhaps on a patient with an unstable metatarsal fracture that I think will have significant difficulty being non-weight-bearing.
Also, when you prescribe a bone stimulator, you usually have to write a note to justify its use. Sometimes, I have had it written by the bone stimulator company based on my note and they ask me to sign it. Read what you are signing because it may be an exaggeration. There are many indicated uses for these devices, however, stable osteotomies are not one of them. We shouldn't waste thousands of dollars unnecessarily and then complain that the fees we get for our surgeries are too low.
Kenneth Meisler, DPM, NY, NY, kenmeisler@aol.com
04/19/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
Evaluating All-Purpose Lasers (John Moglia, DPM)
From: Elliot Udell, DPM
Calling out for suggestions on PM News is a good start. Another good way to find out about lasers is to attend a large podiatry convention where there will be many vendors displaying lasers. I would assume that the 2011 APMA convention in Boston would be an ideal place to see many lasers displayed. This way, you can physically feel what it's like to hold and use a particular product, as well as get references from the reps on other doctors using their devices.
Prior to buying an expensive laser, it is important to evaluate the company itself by finding out how long they have been in business and how many units they have sold. One would not want to have the experience of spending 35 thousand dollars for a laser only to find out a month later that the company went under, leaving customers with no support for their unit.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
11/27/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Parity or Dental Rip-off?
From: Ray Brown, DPM My daughter had to have four wisdom teeth removed (below the gum level). The procedure took 25 minutes. The bill was $2,385. So rounding the number, this is over $4,000/hour for an in-office procedure. What can you do in your office to generate $4,000/hour? When I compare this to the average bunion involving exposed bone, osteotmies, K-wires, etc,. and we might get $400 to $1,000 and it takes considerable longer (including multiple post-op visits) I can only conclude we need parity with dentistry, not medicine. Ray Brown DPM, Cornelius, NC, raybrown@bellsouth.net
07/26/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatry Hall of Fame Thank You
From: Lynn Homisak As I humbly sat on the dais among many of podiatry's “greats” - about to receive what was the most prestigious award in my lifetime – a blanket of forgetfulness covered me. In his "roast", Jason Kraus managed to humorously point out some really important people whom I know. Afterwards, even with a prepared acceptance speech in front of me and a case of individually wrapped bottles of wine ready for distribution, I neglected to shed light on who the important people in my life REALLY are. I would now like to take this opportunity to publicly acknowledge and thank those individuals, there in the room that day, with whom I proudly share this Podiatry Hall of Fame spotlight and all that this Lifetime Achievement Award represents. I would never have received such an honor were it not for their unselfish guidance and support which has helped influence and shape my career: Jason Kraus of Langer Labs, whose friendship, ethics and loyalty I continue to respect and admire; Denis, my husband who truly is the wind beneath my wings, my children, Jessica, Kristy, Nick, and Ben, Dr. Roy LaBarbera and Mr. Glenn Lombardi (of Officite) who each made “day trips” from the eastern side of the country just to be with me on my special day, Dr. Barry and Hermine Block who continue to make me look good as an author, and to Dr. Howard Schaengold, Dr. Glenn Gastwirth, Dr. Donald and Ann Orminski, Yolanda Christianson, Dr. Hal Ornstein, Dr. John Guiliana, and Dr. Susan Scanlan for their teachings and advice. These are among and always will be to me...the really important people in my life! My warmest congratulations once again to Dr. Allen Jacobs – I was honored to share this Hall of Fame induction with you!
Lynn Homisak, PRT, Renton, WA, lynnprt@msn.com
07/15/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatry’s Limited License (Michael Forman, DPM)
From: Narmo L. Ortiz, Jr., DPM While I agree with all the previous posts about the advancements that have been accomplished by our profession, the most important one that we are missing is equality of pay for the procedures we perform. If all the battles that the profession has fought for recognition will lead to that goal, then it will all be worth it, and we just have to be a bit more patient. When I went to podiatry school, no one offered me a discount on my student loans. Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com I agree with Dr. Forman that great things have happened in the field of podiatry over the last 50 years. And in truth, our license does not limit us as specialists...we can treat any and all foot problems that may present to the office, without exception. While it is true that we are not MD's and cannot treat systemic pathology, is that now and has that ever been our raison d'etre? I think not. In my opinion, the only reason this whole issue keeps coming up is that podiatrists… Editor’s note: Dr. Kornfeld’s extended-length letter can be read here.
07/12/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: OPEIU and Podiatry (Gregory T. Amarantos, DPM)
From: Michael Wodka, DPM I am writing this letter in response to Greg Amarantos’s comments that appeared in this forum yesterday. It is difficult to address a broad comment, such as Greg made, in any short manner. Annually, the OPEIU issues, to a meeting of executive directors of Guild states, an accounting chart that displays the aggregate income from and expense paid on behalf of the Guild. From each member’s annual per capita payments, the OEPIU pays a portion to the AFL- CIO, the State Fed AFL-CIO, the OPEIU Defense Fund and OPEIU member benefits.
The remainder of the dues goes to the general fund of the OPEIU. From that fund, the OPEIU hires the lobbyists for national and state issues, pays its dues to podiatry-related national health interest groups and makes grants to... Editor’s note: Dr. Wodka’s extended-length letter can be read here.
07/08/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Physician Status in Title XIX (Randy Brower, DPM)
From: Jon Hultman, DPM, MBA As the executive director of a state organization that has a hard-working and committed board of leaders who have been very effective in passing increased scope and other types of legislation that favorably impact practicing DPMs, I am curious to know how state leaders might be able to “standardize scope of practice in each state” (a goal I agree with) without also having a strong state organization? Since Randy Brower advises us to drop out of APMA, this is, by definition, a recommendation to drop out-of-state organizations too. With no state organization, how would the leaders in Arizona ever gain the right to amputate, or have any influence on issues affecting their collective futures, for that matter? This would be the eventual outcome for all states should DPMs choose this path. While we all need to work harder to make our state organizations even more effective than they already are, it is difficult to envision a very bright future for practitioners if no organization existed to protect and advance the profession.
Jon Hultman, DPM, MBA, Executive Director, California Podiatric Medical Association, jonhultman@gmail.com
07/01/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Loss of Medicaid for Podiatric Care
From: Gregory B. Nellis, DPM
The loss of Medicaid podiatric coverage in more and more states is disheartening. Podiatrists in New York have been discriminated against for years. The key here is to realize that the remedy to this problem is at the federal level, and not by attempting to fight each and every state. We need unity of effort to get the federal legislation passed that will require all states to recognize us as physicians.
Gregory B. Nellis, DPM, Gloversville, NY, gbndpm@yahoo.com
06/29/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Langer and Orthotics (Paul Liswood, DPM)
From: Keith Gurnick, DPM I personally know Jason Kraus, who runs Langer, and have always found him to be upfront, honest, and reputable. I have used Langer Labs for orders in the past when they had a branch in California. I still use them infrequently for specialty items, where they do a very fine job producing a custom orthotic from their New York facility. Maybe Langer labs is filling orders from a podiatrist or other "licensed" medical professional qualified to prescribe orthotics who might be working at, or affiliated with, the shoe store. If so, there is really little you can do about it. If, however, the lab is filling orders from "just anyone" who is sending in foam foot impression orders to be filled, then I suggest that you find another lab to fill your patients' foot orthotic orders. Try to find out exactly what is going on first by either asking your patient or phoning the shoe store and asking to speak with the person or doctor who does the foot orthotics. Take time to actually visit the store, and/ or phone Langer Labs in NY. They may not be aware of what they are doing, and if notified, they could put a stop to filling such orders. Personally, I will no longer voluntarily support any company that used podiatry when they needed us, and then branched out direct-to-the-public to increase sales, market share, and profits. I work for my patients and my patients' dollars pay my bills. Why spend your patients' dollars at an entity that supports your competition? Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
06/24/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Dragon Questions (Simon Young, DPM)
From: Carl Solomon, DPM
Could it be that Dr. Young is describing the problem where, on laptops with a touchpad, the cursor mysteriously disappears, then pops up at some random location on the screen? That's not unique to Dragon, nor to Microsoft Word. It usually has something to do with any inadvertent contact with the touchpad. It drove me nuts for a long time until I found a couple of solutions. Option one is to use an external mouse, and disable the on-board touchpad. Option two is to download a free program called "Touchfreeze" (easy to find using Google). It detects that you're using the keyboard, then momentarily inactivates the touchpad.
Carl Solomon, DPM, Dallas, TX, cdsol@swbell.net
06/23/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Vote for Podiatric-Run Charities
From: Al Musella, DPM Chase bank is running a contest on Facebook, where you can vote for your favorite charities, and the top 200 win a big prize. There are a few podiatry charities listed. Vote for them all (You can vote for up to 20 charities). click this link: While there, please vote for my brain tumor charity also (search for it) - the Musella Foundation For Brain Tumor Research & Information, Inc. Al Musella, DPM, Hewlett, NY, musella@aol.com
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