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01/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Bone Mineral Density Testing (Joe Agostinelli, DPM)
From: Robert Bijak, DPM
Recollection of first year physiology will remind one of the multiple systemic influences on bone such as parathormone from the parathyroid gland, calcium and phosphate exchange via the kidneys, testosterone and estrogen effects on matrix formation, etc. As limited license practitioners, we are not recognized to treat systemic disease.
I know very few podiatrists who need to do density testing prior to surgery. For decades, x-rays have been quite good and cost-effective in making surgical decisions. Also, before "giving supplements, consider referring to someone who actually knows why the density is decreased and actually treats the etiology, like an endocrinologist. The insurance companies are correct not to pay podiatrists for this test.
Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com
Other messages in this thread:
10/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3B
RE: Vibration Anesthesia Device
From: Charles Morelli, DPM
I am surprised at the interest this device and topic have evoked. We all know that the pain associated with an injection is from the medication filling the space in which it is being injected into. The pain is almost never associated with the initial stick of the needle. I've always found a quick blast of cold spray works perfectly. I don't use ethyl chloride because it's just too expensive. Why waste your money?
For the benefit of the young practitioners reading this, if you simply insert the needle quickly, the pain that may be sensed is minimal at best (with the exception of the heel). Then, inject slowly to minimize the discomfort. My understanding is that the vibration device does little to minimize pain around the fat pad of the heel or any deep injections (sinus, ankle, neuroma, etc.). For digital or nail anesthesia, try to avoid injecting directly at the level of the joint. Instead, insert the needle point directly associated with the middle of a phalanx. There is much more soft tissue between joints for fluid to fill into, as opposed to directly around the joint itself.
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com
03/26/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Appoint an Inspectress (Hal Ornstein, DPM)
From: Charles Morelli, DPM
It sounds like Dr. Ornstein needs a better cleaning service? After reading his employees' very long list of over 60 individual items (all of which I agree with) that need to be addressed, I compliment him on his ability to get all of this done for $10 a week. Does your employee have a sister? If so, have her contact me. She's hired!
Charles Morelli DPM, Mamaroneck, NY, podiodoc@gmail.com
03/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)
From: Marc Garfield, DPM
If you think ICD-10 is more accurate, look up ICD-10 for plantar fasciitis, M72.2. Note that it is still the same code as plantar fibromatosis. M72.2. No laterality is used for plantar fasciitis, but you will need laterality for bunions and hammertoes. Both fingers and toes share the same L60.0 code in ICD-10. Do you still think that the “accuracy” will make your claims process more effectively?
We are the last county to convert to ICD-10. Most did so 10 years ago. There are no crosswalks planned. There have never been crosswalks. Only 26% of claims could be crosswalked, if there was a crosswalk. Does anyone out there think that $80,000 per 1-3 doc practice could be put to better use than a new diagnosis classification system.
By the way ICD 11 is scheduled to be released in 2015. At the very least, we should encourage our associations to support the AMA in killing or postponing the ICD-10 implementation.
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net
02/17/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Source for Medical Nail Technicians (Tracy Edwards)
From: Robert Spalding, DPM
Information on medical nail technicians can be found at Medinail Learning Center, medinails.com. The course is 14 modules online, 7 in a pre-requisite course called the "Advanced Nail Technician," and 7 more in the medical nail technician program that trains technicians specifically to work in a podiatry office. There are three exams during the courses and a 40 hour internship is required in a podiatry office or podiatry clinic following the passing of all the exams.
To find the current graduates, go to the home page and click on graduates.mln, which helps podiatrists find a nail technician who will fit well in their offices. They provide three hours of free consulting for any podiatrist who 1) hires an MNT and 2) wishes to set up a pedicure area in the offices.
The MNT can be one of three workers in your office. 1) performing cosmetic pedicures on your patients and bringing in new patients, 2) performing routine foot care and assisting the podiatrist and 3) doing both. These nail technicians are usually the top technicians in the field who wish to work aseptically and in a podiatry office. If you have questions, email me.
Robert Spalding, DPM, Signal Mountain, GA, rts9999999@aol.com
11/11/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Service to Determine Deductibles and Co-Pays? (Eric Trattner, DPM, William Tenney, DPM)
From: Marc Katz, DPM
It is admirable that these doctors have provided a service to benefit physicians. However, there is no service that can guarantee accuracy and up-to-date data. With that being said, we use CSNAP for Medicare, UHC, BCBS, and other carriers have a calculator for this purpose. Billing programs have access to data. And finally, you can request a fee schedule from each carrier specific to your codes.
We have used this method with excellent success. We do this the day before patients arrive. Patients understand that they will pay their co-pay and deductible at their visit. They are fully informed. The real key is friendly but aggressive and knowledgeable front office staff and a system that monitors daily receivables closely.
In these days of increasing costs and lower reimbursement, I prefer my method. I have no desire to shell out more money for a service that already exists.
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
09/22/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Negotiating Credit Card Fees
From: Eric Edelman, DPM
The amount you pay to have credit cards processed is negotiable, and thanks to electronic communications, it is easily done. If you are processing credit cards, you get a monthly statement that shows the transactions, broken down by both day and type of card used.
You can get competing quotes from local card processors, banks, credit unions, or POS companies. Simply scan and email or fax the statement and wait for the quotes to come back. In my case, my current processor matched my best quote, so I have no changes to make other than enjoying a monthly savings on the swipe fees. The discount will apply to Visa, Mastercard, Discover credit, and debit cards. American Express still uses its own system, and thus far, I have not found a way to negotiate with them.
Eric Edelman, DPM, Syracuse, NY, ericedelman@gmail.com
07/29/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Supergroup vs. IPA (James J DiResta, DPM)
From: Bret Ribotsky, DPM, Lawrence M. Rubin, DPM In answer to the question regarding the different models in putting the "perfect" group together in your area, I did a special interview with David Helfman, CEO of Village Podiatry, where for 20 minutes he outlined the process and the model to begin the path of putting a super group together. The interview can be heard by clicking here. Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com I think Dr. DiResta should be applauded for sounding the warning whistle. Podiatrists will either be included in the emerging Medical Home and Accountable Care Organization systems just around the corner in healthcare reform, or face, as Dr. DiRiesta states, “catastrophic consequences.” These organizations will have to include foot care services – and if there is an area-wide, organized foot care IPA network focused on providing quality care at reasonable charges negotiating with these organizations – who would doubt that it will have an advantage over a solo podiatrist to gain foot care referrals. And if you are in an area where a foot care IPA is negotiating and you are not a part of it... well, forewarned Is forearmed. In Las Vegas, we are well on the way to developing a podiatry-driven, multidisciplinary IPA with a primary focus on diabetic foot care. We will offer healthcare payers a coordinated care program capable of preventing serious complications and amputations. We are involving hospitals, surgicenters, and wound care centers in our IPA program, and even local and State of Nevada governmental health agencies are showing interest and support for what we are doing. No one has a crystal ball to foresee the future of podiatry – but, the old saying is ever true: There IS power in numbers. Lawrence M. Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com
07/14/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Cerner/Wisdom
From: Paul Somers, DPM Cerner/Wisdom has been in business for many years and were originally DRSoftware, which was a podiatry company and had great service. As they have grown/merged, they have had serious issues with service. Also, their main focus now is large group practices, primarily anesthesiology ones - this is a very different billing "animal' than the podiatrist's office. Their contracts are very long and difficult to manage. I would hesitate to get involved in a five-year contract period with them - we are clients of theirs, but would change if we could find someone else who could transfer our data and get us up and running reasonably, but the transfer issues are very costly. Paul Somers, DPM , Nashville, TN, optim37209@hotmail.com
06/19/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Super Group Practice Model, How Do I begin? (David Helfman, DPM)
From: Sloan Gordon, DPM I want to comment and highlight some of what Dr. Gordon has said. Some of the key ingredients to successful mergers are “shared values” and starting with “entrepreneurial docs.” You have to make sure that everyone is on the same team. There is really no easy way to do this, but it can be done, if you are all committed. Trusted leadership and a competent management team are going to be the keys to your success. You can’t have 20 chiefs running the show. One thing I have found is that committees in the beginning are good but can also slow down progress. My biggest concern in the current marketplace is that you see lots of consultants charging fees regardless of whether the group mergers are successful. I also urge each and every one of you to view this process as creating a healthcare company with some type of vision for either a liquidity event or strategic partner who will infuse capital into your final model at a multiple far more than you would ever get as a practicing physician. Unfortunately, as a practicing physician, you are only worth fifty cents of every dollar that you collect, but as a healthcare company with all the right ancillaries, your value goes up exponentially. My only added recommendation is to make sure that you do your homework and seek wise counsel, but don’t be penny wise and pound foolish. It’s going to cost you for top talent, and that is what is required for running a successful company. David N. Helfman, DPM, Atlanta, GA, dhelfman@vpcenters.com
06/18/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Super Group Practice Model - How Do I begin? (David Helfman, DPM)
From: Sloan Gordon, DPM I think that was a great response from Dr. Helfman, however, there is an easier way. You don't need to reinvent the wheel. We started with a "steering committee" of entrepreneurial docs and sought out companies who facilitate this process. We vetted each company and found the one we felt worked best and was most viable. Just as was done in Dallas with the formation of a SuperGroup, we hope to image their structure in Houston. There are fewer headaches, enormously less fees, and it can be done without looking for a lawyer, an office manager, an MBA, etc. The right company will have all of those ready to go. The membership is the key. They have to recognize the importance of belonging to a group; to realize the group runs the "facilitator"; the group makes the decisions. Start with a core, get the practices going, get a good software platform. When things are smooth and you have negotiated better insurance contracts and benefits, move on the ancillaries, where there are significant financial rewards: PT, MRI, lab, ASC, mobile laser, home health, home infusion, and so on.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
05/21/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Kudos to Dr. Gurnick and PM News
From: Chuck Ross, DPM I want to express my thanks for the superb service that PM News provides to allow colleagues to interact on a global basis. This was never more evident over the past two weeks. I had originally written for assistance regarding a "patient" with a drop foot and received many wonderful helpful replies. The most notable one was from a colleague, whom I have never met, and he forwarded a brace for my wife (the patient) to wear at no charge to me. He refused payment and was offering this device as a caring individual. We were both truly touched by his graciousness, concern, and generosity. Dr. Keith Gurnick's patients are lucky to have such a fine individual as their podiatrist. Thanks again, for making PM News a personal, meaningful means of sharing. Chuck Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com
05/19/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Practice Fusion EMR (Michael Brody, DPM, Larry Kosova, DPM)
From: Multiple Respondents The world lives on interfaces! There are even issues with the programs that Dr. Brody represents, as they must have interfaces for all of the extra modules that you will need to purchase. Even their EHR and PM have to interface behind the scenes. I highly doubt that each of us will need our own IT departments to debug our interfaces. Let's get away from the tech lingo. That comment is unrealistic and a scare tactic. I happen to be a computer programmer and have taught systems architecture, and I don't buy it. Since Dr. Kosova has no interest in any of these companies like Dr. Brody, I believe his research and comments are excellent points with a good initial evaluation of the software. The bottom line is that you need to do what is best for your practice. You cannot just support someone because they support podiatry if it is not the best solution. Some of these programs mentioned have major problems and are too small to survive. Let's hear from some people that don't have ties to these companies so that we can get some real information please! Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com I am compelled to enter my opinion once again regarding running one’s office using EHRs that work in the “cloud.” My two offices have been paperless since October 2009 when we began using Office Ally for appointment scheduling, inter-office memos, comprehensive notes, complete patient records, electronic prescriptions, lab scheduling and results, etc. We have done our billing through them for the last four years. It has been seamless. I have a computer (I use "all-in-ones" to save space) in each treatment room. There was a learning curve, and we input podiatry-specific macros, etc. It costs about $70 per month for everything. The cost is so low because Office Ally is also a clearinghouse, and your billing, for the most part, goes through them and the insurance companies pay them a few cents for each claim...you may still print your own statements. Over 6,000 physicians use their service. Would you rather put out $25,000 dollars just to get some back from Medicare/Medicaid or would you rather just buy your computers, modems, etc. and spend less than $1,000 per year to have a comprehansive system? Disclaimer: I use this product but have no financial interest in it. My theory is simple...the more doctors who use it, the stronger it becomes. Martin R. Taubman, DPM, MBA, San Diego, CA, mtaubman@san.rr.com I have just read Dr. Kosova's response to this thread with great interest. This thread is getting quite interesting and those following it will have the opportunity to learn a fair bit about EMR in general. I asked a number of similar questions of Sabas when speaking with him regarding back-ups and retrieving data. My take away from that conversation is that… Editor’s Note: Dr. Brody’s extended-length letter can be read here.
01/14/2010
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3 (CLOSED)
RE: My New Career as an Orthotist (Larry Cohen, DPM)
From: John K. Lampe, Ira Baum, DPM I could not agree more with Dr. Cohen’s comments. No clinician is better positioned than the podiatrist to treat all aspects of the diabetic foot. Public health officials in countries like India, where diabetes cases are exploding in number, are bemoaning the fact that they have so few podiatrists. There is a huge need worldwide for care, ranging from preventive foot care to highly complex surgery. Podiatrists have already supplied so much of the cutting-edge research on diabetic foot care. These are not easy cases. An emergency medicine physician I know really enjoys working with podiatrists because they are willing to take on these tough cases. In sum, the need is there, and podiatrists are meeting it. As an outsider, it seems to me your profession has a bright future. John K. Lampe, President, Tamarack Habilitation Technologies, Inc., Blaine, MN, johnl@tamarackhti.com When I made my initial comments, my intent was to take this individual and use him as a model to illustrate the issues confronting our profession. I didn't want our members to debate areas in which we excel, but rather the direction our profession is evolving. I would like to close this topic by using the preponderance of post-graduate surgical training as a barometer of where our profession appears to be going, and how our leaders envision our profession to ensure parity for podiatry in the coming years.
Ira Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net
03/11/2009
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: PM Podiatry Hall of Fame
From: Lynn Homisak, PRT When I worked for Dr. Roy LaBarbera during his APMA Presidency, it was always fun to receive one of John Carson's phone calls. We'd chat for half a minute; then (with a patient standing at the front desk) I would dial the doctor to say, "Doctor, Johnny Carson is on the phone for you!" The patient’s eyes would light up and I would just smile. I have not seen or spoken to John for some time now, but I will never forget him! To me, he has always represented class and integrity. He not only talked the talk, but walked the walk for our podiatric profession. It's nice to see he is finally getting the recognition he deserves. Congratulations to both him and Dr. Hal Ornstein! Lynn Homisak, PRT, Seattle, WA
02/04/2009
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: EMR and Obama (Richard A. Simmons, DPM)
From: Robert Boudreau, DPM, Jim DiResta, DPM, MPH
Maybe I am being too "big brotherish", but I am not sure I WANT all healthcare providers, hospitals, pharmacies, etc to know all about me. Where does it stop? And who deems what "as is necessary" means? Can insurance companies review EVERYTHING about me? What about the government? And if so, WHO in the government? When the time for euthanasia of old folks comes around, I want to make sure they (Obama’s administration) knows as little as possible about me. My fear is that this is a very slippery slope, and we have already headed down it. Robert Boudreau, DPM, Tyler, TX, rbftdoc@aol.com I agree with Dr. Simmons that the implementing of EHR in our practices is truly a necessity and anything less is not worth considering. However, having the privilege of practicing in a local community chosen by the Massachusetts e-collaborative to implement EHR and having now worked with an EHR for nearly 3 years, I can assure you the "ability to access patient data" in an HIE, health information exchange, is not as of yet reality. I have been spending a good deal of time on a steering committee trying to work out the functionality to bring data from multiple EHRs into a central repository that is "rich" enough to be practice-worthy but as of today, is just not there. Like some other communities, we can access from a central database some information like labs,radiology imaging reports and prescription history through SureScripts, and even provide "patient driven" health information record through a patient portal such as Google Health or Microsoft HealthVault but the image of an Health Information Exchange (HIE) with a dependable source of patient history and progress notes in a central repository that is physician and specialty physician driven and in "real time" is still the future. When this is in place, future ramifications to our practices and quality initiatives that will drive reimbursement will bring us all to a new level of "best practices" and place the days of The Healthcare Effectiveness Data and Information Set (HEDIS) measures and quality measures into the dark ages but for now, it's just not there, not yet. Jim DiResta, DPM, MPH, Newburyport, MA, jsdiresta@comcast.net
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