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02/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Overburdened by Paperwork (Joseph Borreggine, DPM)
From: Howard R. Fox, DPM
With all due respect to Dr. Borreggine, if you’re losing patients because of an excessive amount of paperwork for a new visit, you might want to consider what you’re asking them to complete before they get to your office. My patients complete a simple, one-page registration form that captures basic information. The opposite side of this form is a simple privacy policy.
We don’t use any forms for medical histories, medications, allergies, etc. Every new patient is brought into the consultation room where I personally take their medical history. It takes less time for me to ask pointed, relevant questions that relate to their issues than it would take for them to tell me about the boil on their buttocks when they were age 16. Taking your own history helps establish the doctor-patient relationship. On average, it takes about 2 minutes for a patient to fill-out the registration form and sign the privacy statement, during which time, we photocopy their insurance card, and less than 5 minutes to sit in a non-medical room and talk about why they need my help.
Having the unfortunate experience of being a patient myself in more than my share of doctor’s offices, I can tell you that it’s frustrating for the patient as well as the doctor to feel like you’re buying their house when you come to a new doctor. First impressions last a long, long time.
Howard R. Fox, DPM, Staten Island, NY, fox.howard@gmail.com
Other messages in this thread:
09/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Kudos to Podiatric Suppliers
From: Michael J. Schneider, DPM
I recently responded to a post regarding retirement. In the post, I mentioned that in my retirement, I was doing "pro bono" podiatric care at an indigent facility and the Denver Rescue Mission here in Denver, Colorado. I received a response from Chris Case of PEDIFIX in which he offered and is donating Pedifix products for the care of the folks at these facilities. Sue Ellen Dercher of GORDON LABS has also donated products. I would like my colleagues to be aware of these magnanimous gestures of suppliers to, and supporters of our great profession.
Michael J. Schneider, DPM, Denver, CO, podiatristoncall@gmail.com
06/15/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: "Unified" Post-Graduate Training
From: Jon Purdy, DPM
I can’t begin to fathom the confusion a regressive sub-division of podiatry would create. The foot and ankle is a complex structure but, my goodness, are we then going to propose separate schooling for the left versus right foot? One should know what they are getting into when they go into a specific medical field. What they choose to do with it after training is up to them. Most orthopedic counterparts don’t do back surgery or even hand or foot surgery. The money and simplicity is in the knees, hips, and shoulders, and guess where most orthopedists concentrate? As of now, I don’t think their associations are considering two-year residencies concentrating only on knees, hips, and shoulders.
Podiatry is begging for solidarity and inclusion. The best way to do that is to unify training, so when it comes to medical and surgical treatment of the foot and ankle, we can say to our medical counterparts, “Yep, podiatry does that.” If the individual decides to concentrate on more specialized aspects of podiatry, then...
Editor's note: Dr. Purdy's extended-length letter can be read here.
06/12/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: "Unified" Post-Graduate Training (Charles Lombardi, DPM)
From: Michael Forman, DPM
Dr. Charles Lombardi made several good points in his posts regarding a one or two-track podiatric residency. I like his thinking. I would hate to see our profession divided between surgeons and non-surgeons. I feel that podiatry encompasses both areas.
Please do not take the words, "minimally competent" as a negative. It just means it is the point where anything below is unacceptable. That being said, we should ask ourselves, "what should the minimally competent podiatrist be able to do?"
I think we...
Editor's note: Dr. Forman's extended-length letter can be read here.
06/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: NC-stat System (Mohammad Sharif, DPM)
From: Richard Rettig, DPM
I have the NC-Stat system in my office. Most major insurance companies have specific LCDs denying coverage for this examination. In addition, I have seen a large failure rate, with the machine unable to obtain a reading, despite following every 'tip' given by the company.
Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com
06/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Unethical Behavior by Foot Solutions (Dennis Shavelson, DPM)
From: Campbell White
There are a few errors in Dr. Shavelson's rant that need to be cleared up. He has described me as a CPed and the national sales manager for the Novascarpa Group. I am neither. I am not a CPed, and I have never advertised myself as being one. I briefly sat in as the interim national sales manager for the Novascarpa Group, but that was almost a year ago, and my responsibilities are regional in nature.
The Chung Shi shoes you mention are not distributed by the Novascarpa Group. They are distributed by Michael Ertl & Associates in Germany. They were briefly distributed by Novascarpa for a few months, before being transitioned back to Europe. Finally, I have never been personally involved in any face-to-face negotiations with Foot Solutions corporate regarding...
Editor's note: Mr. White's extended-length letter can be read here.
05/11/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: Is it Time to Bring Back Chiropody? (H. David Gottlieb, DPM)
From: Dennis Shavelson, DPM
This post unmasks the current sad state of podiatry by revealing a biased posture taken by one of our ranks who passionately feels (as I do as well) that his direction is the best for us to follow. I believe that for the good of our future, we would be better off seeking a middle of the road posture rather than fragmenting our already small forces.
As chiro is "hand" in Greek and has nothing to do with anyone practicing our great profession, I think that using that word is very demeaning coming from a dedicated surgeon like David. Why not posture from my position instead and call us podiatrists, and call him a non-MD orthopedic surgeon?
To offer a more moderate approach, I suggest that DPMs dedicated to practicing wellness, prevention, performance enhancement, quality of life upgrading, and non-operative podiatry be called interventional podiatrists. We would stand in between the pedicurist, the pedorthist, the pharmacy scanner, and the surgeon podiatrist. That way, we would all be podiatrists. I have been practicing my version of the interventional podiatry model very successfully for about two years now as Dr. Gottlieb seems to be practicing his surgical podiatry. Let’s enjoy the future together!
Dennis Shavelson, DPM, NYC drsha@lifestylepodiatry.com
05/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Tip Sullivan, DPM
I do not know how it is in other states, but here in Mississippi, the State Board of Medical Licensure regulates MDs, DOs and DPMs. They are “all powerful.” They will tell you what the standard is and one had better follow their direction or be willing to have your license formally acted upon. If you want to know anything about your issues with them, you have to sue them just to review their records on you.
My experience is that state boards generally adhere to the “guilty until proven innocent” philosophy and that your license to practice is...
Editor's Note: Dr. Sullivan's extended-length letter can be read here.
05/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Jeff Root)
From: Robert Bijak, DPM, Kevin A. Kirby, DPM
As the writer of one of the two letters that Mr. Root referenced, I must take issue with his statement, "We must all accept the limitations of the research environment." We must NEVER accept a poorly constructed study, and must discard its conclusions. There are enough myths in podiatric biomechanics and orthotic theory already. Observer bias is one type of study error, and Mr. Root has a well-known bias in the area of shoe inserts.
Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com
As Jeff Root very clearly stated, the research study on anterior knee pain (i.e. patellofemoral syndrome), which I posted on PM News a few days ago, prospectively investigated the therapeutic effects of foot orthoses versus no treatment over a six week treatment period. The orthoses used were over-the-counter (OTC) orthoses and showed a significant effect in reducing the knee pain with 79% of the subjects who received these OTC orthoses (Mills K, et al., 2011).
Certainly, it seems plausible if OTC orthoses can have this much therapeutic effect for the treatment of patellofemoral syndrome by presumably altering the kinetics and kinematics of the foot and lower extremity, then the judicious use of prescription foot orthoses made with modifications such as inverted balancing position, well-formed medial arch, medial heel skive, and varus forefoot extensions will have an even greater potential to relieve the pain from patellofemoral syndrome by more specifically altering the kinetics and kinematics of the foot and lower extremity in order to address the abnormal biomechanics that result in this condition.
Unfortunately, at this time, no research studies have compared the therapeutic efficacy of OTC to custom foot orthoses for the treatment of patellofemoral syndrome. However, in my clinical experience and that of many other sports podiatrists who routinely treat cases of patellofemoral syndrome in running and jumping athletes, specially modified prescription foot orthoses are quite effective, along with hip and thigh strengthening exercises, in successfully treating this painful and disabling condition.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
04/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Sterilizing Bits Between Debridements (Alan Meyerberg, DPM)
From: Barry Mullen, DPM
Hysteria is probably overstating the podiatric mindset, but I suggest we all don't underestimate the well-known side-effects of breathing and contact sensitization of nail dust/particulate matter. Various delayed hypersensitivity reactions and pulmonary side-effects from chronic, repeat exposure are very well documented. Listed below is a microcosm of the plethora of articles written on this topic for review.
The first publication I'm aware of that alerted clinicians to these complications is Pugh,J., Skone, JF 1972 "The health of the chiropodist in a developing community service" The Chiropodist 27(2)53-55
Millar demonstrated a 41% asthma increase in podiatrists relative to...
Editor's note: Dr. Mullen's extended-length note can be read here.
03/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)
From: Edmond F. Mertzenich, DPM, MBA
The main question I had about this particular posting was where the figures of around $80,000-$270,000 are coming from. As has been posted, ICD-10 has been around for a while with the codes available for free from CMS. I would like to know how these figures were generated. I have a hard time understanding this because if the codes are free, and they have been already developed, there is no cost for designing them.
As for computer programming (of which I’m not very knowledgeable) to me it is mostly a matter of just putting the codes into a program, changing a few boxes to enter the codes, and making sure the information is transmitted correctly. CMS has mandated version 5010 usage by June 2012. Version 5010 allows for ICD-10 transmission. If these costs are true, then what is driving them?
Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com
03/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Appoint an Inspectress (Hal Ornstein, DPM)
From: Sam Bell, DPM
Back in the late 1960's, Dr. Leonard Hymes taught a wonderful practice management section at PCPM. One of the things he stressed was to sit in the exam chair and observe the treatment room from the patient's point of view, and then do the same with the rest of the office. 40 plus years later, it is still great advice.
Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com
03/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: ABPS Name Change (M. W. Aiken, DPM)
From: Bryan C. Markinson, DPM
I have always believed that the ABPS is one of the best-run entities representing DPMs. When I visit a colleague who has the ABPS certificate on the wall, there is no question that it indicates to me a superior level of dedication and skill that resulted in the attaining of that status.
But my adoration ends there. It seems that most DPMs with the ABPS credential, "the credential you can trust," strongly favor the name change designation to American Board of Foot and Ankle Surgery. The most often stated reason is that it most accurately reflects to the public what those DPMs with ABPS certification most often do. Really?
I am also concerned about the renewed attack on...
Editor's note: Dr. Markinson's extended-length letter can be read here.
03/15/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Changing Banks for Medicare Direct Deposit (Joe Borden, DPM)
From: Paul Kesselman, DPM
An EFT application should not require any modification of your Medicare status with your carrier. It should only require a new EFT application. This is a simple form which may also require either a cancelled check or a letter from your bank. For most Medicare carriers, the change should only take about three weeks.
Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net
03/14/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Study Guides for ABPS Re-certification Exam (Ann Miller, RN, MHA)
From: Andrew Shapiro, DPM
I'd like to alert PM News readers about a negative experience I had with Podiatryprep.com (Foot & Ankle Research Consortium, Inc.). On the recommendation from a PM News posting, I purchased the ABPS Re-certification version for $350. I selected them because they advertise "interactive examination simulations" and their order form includes "Questions and Answers." The (CD) study material arrived with no such "Q &As". It was strictly a study guide. Since I had numerous study guides already, I had no use for it. I tried to contact them by phone and e-mail numerous times. Their only response, by e-mail, was an offer for me to purchase an additional "Surgical Q&A CD" for $250! Buyer beware.
Andrew Shapiro, DPM, Valley Stream, NY, drshapbark@aol.com
03/13/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Depreciated Value of Equipment (Name Withheld)
From: Steve Goldman, DPM, MBA
Depreciation, or as it's also known, Accelerated Cost Recovery (ACR), is a method of valuing an asset (instrument or equipment for example) that is worth less over the time it has been used, or put into service. There are many methods of calculating depreciation, but the most common accounting method is something called "Straight Line Depreciation."
Let's say you purchased a treatment chair for $10,000 today. Let's also say that you anticipate the expected useful life of the chair, for argument's sake, to be 7 years. Let's also assume that the asset (treatment chair) decreases in value 10% each year it is used. So a depreciation schedule for the chair would look like:
Time (Year) Depreciation Accumulated Depreciation Net Value
0 $ - $ - $ 10,000.00
1 $ 1,000.00 $ 1,000.00 $ 9,000.00
2 $ 1,000.00 $ 2,000.00 $ 8,000.00
3 $ 1,000.00 $ 3,000.00 $ 7,000.00
4 $ 1,000.00 $ 4,000.00 $ 6,000.00
5 $ 1,000.00 $ 5,000.00 $ 5,000.00
6 $ 1,000.00 $ 6,000.00 $ 4,000.00
7 $ 1,000.00 $ 7,000.00 $ 3,000.00
Time 0 represents the day of purchase. After the 7th year, the net value of the original asset that was once worth $10,000 when it was new, still has some residual value. In this case, $3,000. This amount at the end of the useful life of the asset is called the "scrap value."
Steve Goldman, DPM, MBA, NY, NY, stevegoldman@att.net
03/12/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Depreciated Value of Equipment (Name Withheld)
From: Robert Wunderlich, DPM, George Jacobson, DPM
Depending on the age of the equipment, it may already be fully depreciated (from a tax standpoint). I suggest making a list of the equipment and the date(s) of purchase, and discuss this with your accountant to see if there would be any additional depreciation deduction(s) available when you assume ownership of the practice. Most office equipment is considered fully depreciated after 5 or 7 years. Also, see the IRS free Publication 946, How to Depreciate Property at irs.ustreas.gov/pub/irs-pdf/p946.pdf
Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com
After I evaluated a practice, I sat down with my CPA and explained why the practice fit my purposes, and he explained any tax benefits or liabilities. I suggest that you do the same.
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com
03/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: ICD-10 Preparation (Joseph S Borreggine, DPM)
From: Arthur Lukoff, DPM
I hope this gloom and doom is just that. If the health industry has this shoved down their throats, I can see a lot of health professionals retiring, especially those in smaller practices and serving areas away from metropolitan areas. Most smaller providers will not and should not have to carry that kind of financial burden and put up with that type of payment delay. I hope cooler heads prevail. Or it will be adios to personalized medicine.
Arthur Lukoff, DPM, Ellenville, NY, footdoc45@hotmail.com
03/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Andrew Shapiro, DPM
We have been using the A2D2 DR digital x-ray system for 8 months. The quality of images, ease of use, and support (with no extra fees!) have been superior.
Andrew Shapiro, DPM, Valley Stream, NY, drshapbark@aol.com
03/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: The Technological Imperative: A Warning (Tip Sullivan, DPM)
From: Allen Jacobs, DPM
Dr. Sullivan recently expressed his concerns regarding epidermal nerve fiber density testing. I would like to allay his concerns. I am in possession of 49 published studies examining epidermal nerve fiber density testing published in peer-reviewed, medical, and scientific journals. 45 have been published prior to 2011.
Epidermal nerve fiber density testing has been well-established for the qualification and quantification of small fiber neuropathy, and as a validated methodology to assess response to therapeutic interventions for the management of peripheral neuropathy. I hardly believe this test is "experimental" or "investigational."
There are, to my knowledge, no published peer-reviewed studies to support the utilization of Pegasus grafting for the resurfacing of the first metatarsal in hallux limits/osteoarthritis. This is not to suggest that such an approach may not prove effective. It is however, "investigational."
Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net
03/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: The Technological Imperative: A Warning (Allen Jacobs, DPM)
From: Tip Sullivan, DPM
I write this with the greatest respect for one of our most notable podiatric physicians, Dr. Jacobs. His points regarding technology and utilizing off-label applications of surgical devices made me think of other things along the same line. Perhaps a slightly greyer area, standard of care. I have listened to Dr. Jacobs speak, I believe for Metanx, and I can recall actually believing I should start doing skin biopsies on diabetics and sending them for peripheral nerve density studies following his inspiring lecture.
To me, this was as exciting as going to a national meeting and hearing about some new off-label use of an implant. While this made my Metanx rep very happy, it is not what I would call standard of care in my neck of the woods in podiatry or any other medical specialty. I would venture to say that if I had a diabetic patient who developed complications from such a surgical procedure, I would have to call Dr. Jacobs in my defense. I am sure we would win.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net
02/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Overburdened by Paperwork (Josephine Borreggine, DPM)
From: Richard A. Simmons, DPM
Dr. Borreggine wrote that a patient cancelled before the first visit because of the burden of paperwork. The tone of the cancellation notice blamed the doctor for the burden. Years ago, I pre-empted this type of response by placing the following heading on my office paperwork, “For the service to be paid for by your insurance (including Medicare Part “B”), the 1995 and 1997 Correct Coding Initiatives (CCI) require completion of all pages of this form.”
When there is a complaint, the potential patient is always told they have the right not to participate in Medicare (or any insurance coverage) and simply be a cash-paying customer. I have found that when people understand that the burden was imposed on me and not imposed by me, they empathize with me about where this nonsense originated.
Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com
02/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From Fred Huss, DPM
I'm not sure I understand this debate.
I go to the urologist for my prostate exam.
I go to the ophthalmologist for my eye exam.
I go to the optometrist for glasses.
I go to the dentist for my teeth.
I go to the psychiatrist or the psychologist for meds or talk therapy.
I've been to a gastroenterologist for my colonoscopy.
When I was admitted for CABG....
Editor's note: Dr. Huss' extended-length letter can be read here.
02/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Gerald Peterson, DPM
Many years ago, our state association made an effort to STOP using the term podiatrist in our communications. I personally made an effort at a national level to stop using the term podiatrist in favor of the term podiatric physician and pushed others to do so. I feel the other terms "foot and ankle physician" or "surgeons" is just grandiosing ourselves rather than defining ourselves. We are podiatric physicians and surgeons! Podiatrist is just a short version of the same. What we do and how we present ourselves defines us, but we should ALL use the term podiatric physician in communicating to the public and outside agencies.
We are podiatric physicians and surgeons just like allopathic physicians are medical physicians and surgeons and osteopaths are osteopathic physicians and surgeons. They all have short terms for who they are too - ENTS, pathologists, orthopedists, dermatologists, etc. Let's not get hung up on beating each other up on terms. Our presentation to the outside world should always be podiatric physicians or, if you prefer, podiatric physicians and surgeons (just a bigger mouthful to get out in conversation).
Gerald Peterson, DPM, West Linn, OR, DRP@ifixft.com
02/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: New MD Shoe Company Tells People to “Ditch Your Orthotic” (Kevin Kirby, DPM)
From: Juliet Burk, DPM
I read the comments in PM News with interest about OESH Shoes. All the fuss was enough to drive me to the OESH shoe site. I was interested enough by the concept to order a pair, and have been wearing them almost two weeks. I have also been in contact with the folks at OESH via email.
They have recently changed their marketing stance on orthotics as listed on their website. Although they still preface their page with the slogan “Ditch your orthotics,” they no longer attempt to wholeheartedly condemn orthotic therapy. But I wouldn’t care if they didn’t. Here’s why. First, the shoes are great. I have already...
Editor's Note: Dr. Burk's extended-length letter can be read here.
02/14/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Alan Sherman, DPM
I am a podiatrist and am proud to be one. And if it takes 50 more years to improve the reputation of that brand to the point where we are satisfied with our reputation, then let's all continue working on it Monday morning. I was raised to believe that you don't request or demand a reputation - you earn it and are granted it by others. Yes, don't be shy, show them what you do, show them what you got and the results you get...but you don't give yourself creds. You can apply for them, but they are given, not taken.
Leonard Levy has been an inspiration to me since I was a student at CCPM in 1977, and has been among our greatest ambassadors in the world of medicine. He has upped our reputation, not just by what he says, but by what he has done. I agree with him that we are physicians, we are surgeons, just as we are...
Editor's note: Dr. Sherman's extended-length letter can be read here.
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