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02/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry and FQHC Health Centers
From: Paul Kruper, DPM
The article in Podiatry Management Nov/Dec 2011 regarding this topic effectively outlined the advantages of working in a FQHC clinic; specifically with respect to being part of a primary care team.
Last year, in California, this employment opportunity was eviscerated when podiatry coverage was scratched from the Medicaid/Medi-cal program. Since most patients who use the FQHC clinics have Medicaid, the staff podiatrists could no longer treat those patients unless they paid cash. The PA, FNP, and other allopathic docs took over care of most foot problems previously seen by podiatrists. The physician assistants are now performing Medicaid nail surgery at these clinics.
This is just another example of how quickly and easily podiatry is excluded from mainstream medicine because we do not have a primary care license. The fact that the state will not save any money because the foot problems are still treated, just by different providers, does not prevent myopic public officials from viewing podiatry as an easy target for elimination. An allopathic license would remove the bullseye from our backs.
Paul Kruper, Kingsburg, CA, prkruper@yahoo.com
Other messages in this thread:
05/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Konica SRX 101 X-Ray Processor (Jack Ressler, DPM)
From: Sean S. Ravaei, DPM
I used to have an SRX 101. In the five years that I had it, it did not break down once. It worked great. The only reason that I sold it was to upgrade to a digital one.
Sean S. Ravaei, DPM, Beverly Hills, CA, drravaei@866866feet.com
05/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Sterilizing Bits Between Debridements
From: Jeff Kittay, DPM
I would like to thank all the respondents to my original post, even the unpleasant ones. Those of you who so loftily ridiculed my inquiry may some day be defending the practices you now call state-of-the-art. It was never my intention to claim that my method of practice was superior to anyone else's, only that it is common and not dangerous.
I now stand corrected and have no problem altering my practice methods, though I still know of no published study confirming actual disease spread from a doctor's office to the patient from the use of unsterilized nail burrs. Growing fungal cultures from burrs does not equate with transmission of disease. Our hands, with which most of us touch patients everyday and which we wash scrupulously, are teeming with bacteria and fungi; yet patients escape our offices unharmed.
It was, however, my intention to ask if you feel that my board's requirement that I undergo 30 hours of CME on "hygiene and sterility" was overreaching and excessive. I remain convinced that this is so.
Jeff Kittay, DPM, Boston, MA, twindragons2@verizon.net
05/15/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Hand Instrument Repair (Michael DiGiacomo, DPM)
From: Paul Busman DPM, RN, Hal Ornstein, DPM
I hate springs on all cutting instruments and routinely remove them from all of my nail nippers and other plier-type instruments. I always felt I was working against the spring. Grasp the handle with your index, middle, and ring fingers, and hook your pinky on the inside of the handle. You can easily open and close the instrument with very fine control.
Paul Busman DPM, RN, Clifton Park, NY, paul@busmanwhistles.com
Bianco Brothers (biancobrothers.com (718-680-4492 800-217-0817) repairs and sells many surgical and nail care instruments. They are a family-owned business with great customer service and fair pricing. I have been working with them for years.
Hal Ornstein, DPM, Howell, NJ, halo@footdoctorsnj.com
04/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Satellite Office Build-Out (Jack Ressler, DPM)
From: Jason Cohen, DPM
Our practice (two doctors) has a main office and five satellite locations. We have found it best to rent space from internists or medical centers. The time spent at these locations varies from half a day, twice per week, to an hour or two every other week. The patients are usually scheduled in a condensed block time, which allows us to visit the location, see the patients, and then leave. There is not too much down time. We bring our employees with us, since they know exactly how we work. This also minimizes the impact we have on the office we are visiting.
The overhead is low; you do not need to maintain a full office (e.g., rent, full-time staff, utilities, telephone, etc.). The internists are happy because they are collecting a rent check, and they can offer their patients more services under one roof. You also have access to a steady stream of new patients. You may want to contact a healthcare attorney to set up the lease and other specifics.
The expenses involved to start a satellite office like this are minimal, since the office will already be set up for you to work. Make sure they have an examining table or chair that you can utilize, some storage space, and you are good to go. All of these offices are stocked with the necessary equipment, supplies, and DME items.
Jason Cohen, DPM, Bronx, NY, Phootdr@optonline.net
03/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: ABPS Name Change
From: M. W. Aiken, DPM
I just received an on-line survey from ABPS. They seem to be interested in changing their name by dropping “Podiatry” from their title and changing their name to The American Board of Foot and Ankle Surgery. The current Board seems to be forgetting the essence of our identity as a profession. They seem to forget who we currently are and where we have come from. The fact is if you assimilate to closely with the MDs, then we basically dilute ourselves into extinction. We will lose the uniqueness that makes us so different and very special from all of the rest. And that seems to be an advantage, not a disadvantage as the Board seems to think that it is.
The Board has become an entity that pushes for more rearfoot and ankle scope, and then the lower leg, and now to do away with the title of podiatry. It's very insecure and small thinking. We can continue to progress and evolve in any way we want, but also maintain our own unique identity as podiatrists. One event is not mutually exclusive of the other as the Board seemed to believe that it is.
I vote to keep the name the same and to maintain in the current title “Podiatry.” I am proud to be a podiatrist and don’t want to hide behind the semantics of it all to alter the reality of my true identity.
M. W. Aiken, DPM, Baltimore, MD, mwaikne@comcast.net
03/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Linh Nguyen, DPM
I haven't tried other vendors, but am using an A2D2 DR device and software. They are good guys. They'll change your base completely to fit the DR model. If you are using Traknet as your EHR, then it will be a bonus because the patients' data needed will be synced to the x-ray software. So you don't have to spend time entering in patients' data. I'm spoiled now, getting immediate x-rays.
Linh Nguyen, DPM, Phoenix, MD, footreliever@gmail.com
My experience is with the 20/20 DR. X-rays do not reimburse well, so despite any manufacturer's claims, they do not pay for themselves on the premise of silver recapture, saving boxes of films, and saving chemicals and processing.
The benefits are simply:
1. An instant image that can be viewed from your laptop or exam room terminal (or from home while catching up on charting using terminal services)
2. No dark room needed, so you can...
Editor's note: Dr. Garfield's extended-length letter can be read here
03/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Cheryl Martinetti, PMAC
In our office, we were using a high-end CR digital x-ray unit. We are a very busy 4-doctor practice, and we found that our CR x-ray unit was a choke point in our practice. So, for us, it made perfect sense to replace a fully functional CR unit with a DR unit. The efficiency enhancements that we have realized have more than paid for the unit. We went with a unit from FOZnetworks (foznetworks.com). Their product and support are first class. Unlike all of the other DR vendors out there, this is the only one that offers free lifetime support and software updates. Other companies are charging monthly fees for support. FOZnetworks has saved us thousands.
Cheryl Martinetti, PMAC, Howell, NJ, cherylmartinetti@yahoo.com
03/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Raymond Posa, MBA
I offer the following suggestions when shopping for a digital x-ray unit. While price is important, do not let it be the be-all, end-all in your decision. Some manufacturers are offering very low prices, but then have hidden mandatory ongoing support costs, or they compromise the quality of the unit in its design.
So, what do you look for and what questions should you ask?: Do you have maintenance and/or support fees? Does your unit use direct x-rays on the ccd receptors or indirect? Indirect will significantly increase the life of the unit. How many megapixels is your image? Look for 20 plus megapixels anything less will compromise the quality of your images. Is your unit tailored for podiatry? Many units are scaled down units that are not designed for podiatry or are much bigger units than are required for podiatry.
Raymond Posa, MBA, Technology Advisor to the AAPPM, RaymondPosa@themantagroup.com
02/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)
From: Paul Kesselman, DPM
Considerable attention to this issue has been paid by many organizations representing the various suppliers of therapeutic shoes for at least two years. There has been considerable dialog with the DME MAC Carrier Medical Directors (CMD's) on a number of occasions, resulting in some (but not enough) clarification on the required documentation. To my chagrin, none of these communications has resulted in substantive progress in resolving the issues at hand.
I agree with Dr. Dowell that the most difficult documentation for any supplier to obtain is a progress note from any physician which contains the body of evidence required by a DME MAC.
For most DMEs, podiatrists have the ability to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
02/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: The Cost to Podiatry for ICD-10 in 2013
From: Bruce Krell, DPM
I read a recent article in one of the podiatry journals that the cost to adopt ICD-10 for each individual podiatry practice will be well over $80,000. How is this remotely possible? Could we have a discussion on what this dollar figure is actually attributed to and how we all are to pay for this? If I had to put out that kind of money next year to upgrade with my EMR service provider and billing company, I might as well call it quits. Besides, I'm still waiting on my first meaningful use check. I worked my butt off to do that!
Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net
02/25/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Overburdened by Paperwork (Joseph Borreggine, DPM)
From: Pete Harvey, DPM
Our office has not had this specific response, but there are grumblings among the patients. Almost every office in my area has experienced some type of unhappy patient response to the increase to the government’s request for more and more personal information. Most unhappy are my patients who are the surviving members of the Greatest Generation who fought in WWII. They have specifically told me their friends died at Normandy, Hawaii, Iwo Jima, and many other places to protect our individual freedoms. Chief among these is the right to privacy, including social security numbers and medical information.
The need for this information is now entrenched and will not be reversed. These unhappy patient responses will become fewer as people become resigned to fact that these freedoms are now lost or they just don’t care anymore. Let us all hope we do not look back and say, “ We were just following orders.” “We didn’t know.” “ We thought they were showers.”
On the bottom of my Social Security card there is this statement, “For Social Security Purposes..Not For Identification.” These same cards issued today do not have that statement.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
02/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry and FQHC Health Centers
From: Edmond F. Mertzenich, DPM
Having worked full-time for an FQHC since 2004, I have found the work fulfilling and interesting. The need for podiatric care is significant. I can assure the podiatric community that we are the foot care experts. Working in close proximity with other providers is fun. I frequently see cases that one would only see in textbooks. This includes assorted diabetic complications, infectious disease, neurological issues, and musculoskeltal problems, to name a few. Almost all my work is primary care.
It is a good feeling to have other primary care providers ask me to consult on their cases. It can be frustrating when there is a low compliance rate from patients. As for funding, I believe it would be a mistake to look at Medicaid as the only funding source for podiatric care in the FQHC environment. Many patients are on some form of disability and have Medicare. Those without insurance are given a discount and have to pay a fee to obtain services (and this also applies to other providers). There is the occasional private insurance.
That being said, I think the place to change this funding discrepancy is to get our legislators to support and pass the change to Title XIX funding; to not allow podiatry to be an optional form of care. Without this change, many people will not have access to expert foot care.
Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com
02/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Overburdened by Paperwork
From: Joseph Borreggine, DPM
We rarely ever receive this type of response from a new patient, but it is worth noting because of all the paperwork that patients need to give a doctor to have a complete medical record, comply with HIPAA, and obtain the necessary assignment of benefits and explanation of office payment policies. Whatever happened to the good ole' days of practicing medicine? The government has too much regulation that we pass onto the patient, and hence this type of response...I wonder how much more frequent this will become?
"This is my notice that I would like to cancel my appointment. I am sending it via email so that it can be received before the 24-hour time frame is encountered. I only received the (overwhelming) packet in yesterday's (Friday's) afternoon mail and did not have the time to contact you by telephone during your office hours then. I will not be rescheduling this appointment. The tone and volume of the mailed packet did not convince me that I want your office to be my care provider."
Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net
02/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Marcaine and Lidocaine (Theodore McKee, DPM)
From: Jack Hickey, DPM
We use Teregen Labs in Willoughby, OH at 800-848-0055 for all of our Marcaine, lidocaine, Dex acetate and Dex phosphate (they compound them for individual patients with prescriptions from us). I fax the patient's name, address, and phone on the prescriptions, and these products arrive at our office a few days later.
We've been doing business with them for almost 30 years and have never had a problem. We also get our PumiBars from them.
Jack Hickey, DPM, Levittown, NY, jhickeydpm@earthlink.net
02/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Non-Surgical Treatments Above the Ankle
From: Michael M. Rosenblatt, DPM
With the shortage of residencies, and perhaps some younger doctors not interested in advanced surgery, there is a need to consider non-surgical treatments as well. We agree that podiatry has been a surgical profession. But there is room for a great deal more.
One such option is trigger point injections for myofascial pain and other conditions that affect the anatomy proximal to the ankle. Some state laws are very "generous" in their definition of the ankle, in that they include the talus, tibia, fibula, and defining soft tissues that insert into it. According to this definition, the muscles of the upper leg are in that same group, since they insert into the tibia and fibula. Most podiatry laws are specific in preventing surgery for podiatrists on the knee and above. But they are far less clear when it comes to soft tissue considerations. I hope that as more podiatrists read my article in Podiatry Management on non-surgical procedures, they will consider non-surgical treatments above the knee.
This will result in letters to various state boards around the country requesting clarification of those treatments. I hope that podiatry boards will follow the laws they have and consider muscles that insert (and not just originate) into the tibia and fibula as part of the "functional" foot and ankle. I believe we already have the laws we need to do this in all but six states.
My question to State Board members is: "Do you intend to artificially stunt podiatry by restricting our own published laws?"
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
02/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry Plus Malpractice Insurance (Brett Roeder, DPM)
From: John Murray
Our podiatry group has used Ace/Podiatry Plus Malpractice Insurance for 10 years and have been completely satisfied. It's consistently 20% or more less than what others charge. The key driver to this is that they have various liability pools based on the amount of surgery our podiatrists actually do versus putting all in the same risk pool. Additionally, our agent has proven to be the single most professional resource I have found. He is a true business partner and great resource beyond just getting our policies done at the most competitive rates.
John Murray, St. Louis, MO, jmurray@foothealers.com
02/17/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry
From: Leonard A. Levy, DPM, MPH
Responding to my post in PM News, a number of people did not think we should refer to ourselves as podiatric physicians since specialties like orthopedics, dermatology, ophthalmology, and others do not refer to themselves as orthopedic physicians, dermatological physicians, and ophthalmologic physicians. That is true but, as an associate dean in a college of osteopathic medicine, I am very aware that those who hold a DO degree in the U.S. refer to themselves as osteopathic physicians, not osteopaths.
Even the DO degree is referred to as doctor of osteopathic medicine rather than doctor of osteopathy. DOs call themselves osteopathic physicians whether they practice a medical or surgical specialty. One reason is to distinguish themselves from the osteopath in other countries like England where they do not have a surgical or medical scope of practice. For similar reasons, we should call ourselves podiatric physicians.
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu
02/14/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Disposing of Old X-Ray Machines (Neil H Hecht, DPM)
From: Al Musella, DPM
If the machines still work, perhaps you could donate them. When I was at the NY Clinical Conference, one of the students from NYCPM was asking for donations of supplies for them to bring to Mexico for a medical mission trip. See nycpm.edu/ipc/club.html for details. Or try a local clinic.
Al Musella, DPM, Hewlett, NY, Musella@aol.com
02/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Shoes/OTC Inserts for Size 20 (Chuck Ross, DPM)
From: Cam White, Jeffrey S. Hurless, DPM
Try 2bigfeet.com They have a New Balance 623 in sizes and widths up to size 20 ($75.00). Alternatively, you could try looking up Friedman's Shoe in Atlanta, whose clients include many NBA players with very large feet. I'm not aware of any OTC orthoses made for a size 20 foot.
Cam White, Austin, TX, camwhite.shoes@gmail.com
In response to a recent question asking where Chuck Ross, DPM could find a size 20 shoe: You can find this size and larger at healthyfeetstore.com.
Disclosure: healthyfeetstore.com is run by Dr. Hurless
Jeffrey S. Hurless, DPM, Thousand Oaks, CA, jeffreyshurless@yahoo.com
02/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Surgical Diabetic Fellowship? (Joseph Quattrone, DPM)
From: Christopher M Locke, DPM
We have an intensive program in diabetic limb salvage at Boston University and Boston Medical Center where international scholars are invited to train and work with our clinical and research team headed by Dr. Driver.
Christopher M Locke, DPM, Boston, MA, Christopher.Locke@bmc.org
01/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Exparel Extended-Release Anesthetic (Tip Sullivan, DPM)
From: Sloan Gordon, DPM
I don't know about Exparel (extended release bupivicaine), however, when I am looking for a long-acting local anesthetic, I give a pre-emptive block. I mix 10 mL of Marcaine 0.5% plain with 10 mcg of clonidine (Duraclon). Anectodally, this lasts 12-18 hours. Substituting a longer-acting local like ropivacaine (Naropin) lasts even longer.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
01/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Fast, Reliable Scanner (Mark Ray, DPM)
From: Marc Garfield, DPM, Richard Wolff, DPM
Fujitsu makes the best business-friendly scanners. I have a 6130 which can scan in TIFs, PDFs, and a few other formats; and runs around $900. The Scan Snap is also excellent and much less expensive, but only scans in PDF format. Many EMRs require TIF, BMP or JPEG. Both scan double-sided with one pass. I have had both for a few years, so model numbers and prices may differ now. But Fujitsu holds up well and turn a small stack of paper into an electronic document in under a minute. The organization software with the Scan Snap is also excellent. The 6130 scans go directly into my EMR. Hospitals in this area use the same scanners at work stations.
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net
I have been very happy with Xerox Documate 162 and 272. Both have been great in my practice. Scanning is fast and without misfeeds. Initially, I was hesitant to spend several hundred dollars on a scanner, but it was money well spent. I have had the 272 for 3 years and the 162 for 1.5 years. No problems. The 272 has a card scanner for insurance cards and drivers' licenses. Both scanners are duplex.
Richard Wolff, DPM, Oregon, OH, wolffie@sbcglobal.net
01/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Fast, Reliable Scanner (Mark Ray, DPM)
From: Alan Sherman, DPM, Pete Harvey, DPM
Fujitsu has made the best and most reliable scanners for many years. At Amazon, they list models from $400 - $1500. Whenever I've been in a bank or a law office where a lot of mission-critical scanning is done, it's invariably a Fujitsu.
Alan Sherman, DPM, CEO, PRESENT e-Learning Systems, asherman@presentelearning.com
There are many good scanners. We use a Lexmark 544 and, on some days, scan and import up to two reams of records per day. I have not used a hand-held scanner, but I don’t see how it could scan as fast as a stationary one. You might consult your local IT.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
01/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Transition from In-House to Billing Agency (Cedrick Cooper, DPM)
From: Michael Forman, DPM
Before deciding to go to an outside billing service, you have to do some calculating. You should know what part of your yearly expenses go toward billing, i.e., employee salary and benefits, space, stationary, stamps, clearinghouse costs, etc. The national average for physicians is 7%. How much is the billing service going to charge you? What are the other factors? Be aware of the dangers of one employee handling the money. Is the employee sending out statements on a regular basis? Is she familiar with coding, etc.?
Disclaimer: I currently serve as a consultant to ABC Billing Co.
Michael Forman, DPM, Cleveland, OH, im4man@aol.com
01/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Nursing's New "Doctors"
From: W. David Herbert, DPM, JD
My wife has been a nurse educator for nearly twenty years. I have followed with interest the evolution of nursing education and its latest titles and certifications. A few years ago, the Doctor Of Nursing Practice (DNP) degree was introduced, I believe, at Columbia University. I understand that there are 120 of these programs today, including several on-line.
These individuals are now "Doctors." I believe it is wise for podiatrists to firmly establish themselves as physicians and surgeons of the foot or as licensed medical specialists. I believe this is more important than worrying about the actual scope of practice at this point in time.
W. David Herbert, DPM, JD, Billings, MT, herbert.dpm.rn@gmail.com
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