07/26/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Source for Accu-Mold Substitute (Joan Schiller, DPM)
From: Robert Teitelbaum, DPM
Otoform-K, offered by Alimed Co., and seen in some other "sports medicine" catalogues is my alternative of choice. It is manufactured in Unna, Germany (as in Unna boot). Unna is stamped on the tub.
Robert Teitelbaum, DPM, Naples, FL, Mfvandange@aol.com
04/26/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)
From: Karen Malley Banks, DPM
I am a “call it like ya see it” podiatrist. Every time the subject comes up about billing for nail care, I feel the need to offer a bit of caution. No matter how “clean” you feel about NOT billing Medicare for nail care, you can’t make general statements about coverage without examining the patient.
I personally know a podiatrist who got busted for UNDER-utilization. He went into a nursing home and told them...
Editor's note: Dr. Banks' extended-length letter can be read here.
04/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatry’s Secret Problem (Steven Moskowitz, DPM)
From: Michael J. Schneider, DPM
Dr. Moskowitz’s post was the second post in a few weeks by a member of our profession intimating that there are a significant number of our colleagues who are intentionally scamming/stealing from insurance companies by overbilling and billing for procedures or services not needed.
He based his statement on the fact that Medicare was billed $120 for his mother’s visit with a podiatrist at her assisted living residence and previous nail treatment by other podiatrists. My question would be...
Editor's note: Dr. Schneider's extended-length letter can be read here.
04/23/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Competency of APMA Leadership (Tip Sullivan, DPM)
From: Steven J. Kaniadakis, DPM
I say that the problems of leadership are not the mere focus of the top side of leadership. The bottom side of leadership (no pun intended) must be examined as well. The records show that states (like the one Tip Sullivan, DPM, Jackson, MS practices in) should have kept the one-year post-graduate and "preceptorship" program pathways viable.
Even when these states still carry over this pathway, the states' licensed podiatrist leaderships are insisting that all new DPMs must have a residency, and they are also increasing the number of years of residency training required. There are many DPMs in practice with one year post-graduate training programs. Alaska appears to now have a one year "surgical" residency requirement. MT and WY, I think, still have one-year, post-graduate program requirements.
Steven J. Kaniadakis, DPM, St. Petersburg, FL, stevenkdpm@yahoo.com
02/12/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Kudos to Paul Kesselman, DPM (Eddie Davis, DPM)
From: Hal Ornstein, DPM
I would like to echo the comments of Eddie Davis, DPM about Paul Kesselman, DPM. Durable medical equipment and diabetic shoes have become an integral part of achieving best outcomes and quality for our patients as well as adding to the bottom line. I get to see much behind the scenes and the many hours of dedication and passion to help our profession that Paul has given. Paul, simply stated, thank you!
Hal Ornstein, DPM, Howell, NJ, halo@footdoctorsnj.com
12/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Doppler an Integral Part of a Podiatric Practice
From: Ed Cohen, DPM
The office Doppler can be an invaluable aid to diagnosing PAD. The ABIs, PPG waves, and hallux pressures provide significantly more information about the vascular status of a patient than can be determined by just feeling the patient's pulses. Some patients will not have any ulcers and have a lot of foot pain which is not from an ingrown big toenail, neuroma, or other podiatry problem, but is from PAD.
It is important to determine the vascular status, which can be a real challenge, especially in the geriatric and diabetic population. The podiatric history can be very helpful, however, sometimes on rare occasions a patient could...
Editor's note: Dr. Cohen's extended-length letter can be read here.
09/22/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: New Documentary on Healthcare
From: Bret Ribotsky, DPM
I just saw a private screening of a new documentary accepted for the Sundance Film Festival called Escape Fire: The Fight to Rescue American Healthcare. I encourage everyone to at least visit this page and watch the 3 minute teaser, as this is what our patients will be watching very, very soon. It features Dr. Don Berwick, former head of Medicare/ Medicaid (2010-11), Steve Burn, President and CEO of Safeway, Gen. David Fridovich, deputy commander of the U.S. Special Forces, and Drs. Dean Ornich and Andrew Weil. Do not miss this.
Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@gmail.com
09/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Hospital-Employment — Is it Causing Healthcare Costs to Skyrocket? (Joseph Borreggine, DPM)
From: Robert D. Phillips, DPM
I appreciate Dr. Borreggine’s comments, and he does have some valid points to make. However, I don’t believe the big problem is with the hospital-employed physician. I have spent 15 of my 33 years of practice in the employ of the VA hospital system, and can tell you that there are many reasons to leave private practice for a hospital-employed situation.
The first is that I fully enjoy working in a multiple specialty atmosphere, where I have almost instantaneous contact with the patient’s primary care physician or any specialist who has been used or may be needed for care of the patient. In the private practice atmosphere, there is always a feeling of isolation, which can lead to decreased contact with other physicians. I am not in competition with...
Editor's note: Dr. Phillips' extended-length letter can be read here.
08/30/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Compensation in a Wound Care Center (Ed Dosremedios, DPM)
From: Frank Lattarulo, DPM
As a point of reference:
CPT 11042 is done at our wound institute here in New York: $66.92 approved to pay.
CPT 11042 is done in my private office: $125.33 approved to pay. We then get reimbursed 80% of that of course.
The difference goes to the facility for their expenses, which they also bill and get far more than the $66.92 I receive. Of course, we don't pay for supplies, staff, instrumentation, etc. at the hospital wound center.
Frank Lattarulo, DPM, NY, NY, doclatt@aol.com
07/31/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Best Laser for Onychomycosis (Daniel Waldman, DPM)
From: Marc Katz, DPM
The best laser for onychomycosis is purely subjective and depends on what works best in your hands. We still have no idea what is ideal with regard to wavelength. Most companies have not come up with appropriate standards and protocols and need to do so. Podiatrists will need to do studies that are not connected to the laser company pushing their product.
I personally developed my own protocol and I'm happy with the results. I can tell you that you need to remember the company that took advantage of podiatrists at the start of lasers for onychomycosis. Their goal was to make tons of money at our expense and they did! I have no ties to that company or any other laser company.
The FDA clearance proves nothing when it comes to...
Editor's note: Dr. Katz's extended-length letter can be read here.
07/30/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Best Laser for Onychomycosis (Greg Teles, DPM)
From: Daniel Waldman, DPM
I have used the PinPointe FootLaser for the temporary increase of clear nail in patients with onychomycosis with good results since 2009. The company has provided great support and was the first laser given FDA clearance for this proceedure. In order to get the clearance, the company submitted data to the FDA, unlike most of the other companies who applied as a predicate (similar) device as the FootLaser and provided no data.
Disclosure: I serve on the science advisory committee for Nuvolase and have lectured for Cynosure.
Daniel Waldman, DPM, Asheville, NC, dpmcareer@aol.com
06/11/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Vision 2015, Vision 20/20 (Ed Davis, DPM)
From: Allen Jacobs, DPM
The mandatory 3-year residency is fine in concept, however, to suggest that this will result in uniform educational experiences, particularly in the area of surgical case volume and diversity, is presently not consistent with fact. Not everyone can be, should be, or wishes to be "a surgeon".
It is about time that the APMA take some real leadership in directing the future of the profession. Establish definite guidelines, goals, objectives, expectations, clinical activities for primary care podiatry and for surgery. Define once and for all exactly what a primary care podiatrist is expected to do in practice; then set about residency development to accomplish this over three years. We already have...
Editor's note: Dr Jacobs' extended-length letter can be read here.
06/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Relegating Casting
From: Michael Forman, DPM
I was once a proponent of having assistants take neutral casts for orthotic devices. I would always check the cast and ask to have it replaced if it were unacceptable. I think we might have gotten lazy. After reading my colleagues' responses to this question, I am now back casting these patients myself. Our protocol is to have a floor assistant apply the plaster. We hold in-services from time to time and this is covered in one of our sessions. The assistant will "time" the application so that I can enter the room while the plaster is still moldable (for example when I am doing the previous patient's note). I will hold the foot in "neutral" while he/she applies the plaster to the other foot. Yes, I still use plaster of Paris.
06/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Tablet PC Recommendations (Lori Weisenfeld, DPM)
From: Martin E. Wendelken, DPM
I have extensive experience using tablet PCs for EMRs and digital planimetry for quite some time now and found that the ASUS EEE slate is excellent. It has all the features you need including a blue tooth keyboard, power adaptor, and stylus. You can use the stylus or your finger on the crystal clear screen. It has a 12” screen, 4 gig RAM, and a solid state hard drive 64 GB powered by an I5 Intel processor.
Samsung also makes a similar device with a larger 128 GB solid state drive. It should be noted that there are going to be many new tablet PCs coming later this year running Windows 8, designed to directly compete with the iPad. They will have the same “instant on” no boot up features, dual cameras, along with powerful high resolution retina displays that are expected to exceed that of the ipad.
Martin E. Wendelken, DPM, Bronx, NY, drmew@optonline.net
06/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Tablet PC Recommendations (Lori Weisenfeld, DPM)
From: Marc Garfield, DPM
Your best bet at this time is probably the Fujitsu Lifebook. Toshiba stopped making PC convertible tablets, but the M7xx series was excellent and still is useable, if you can find one. I have thrown out several HP tablets and would not recommend them. Motion and Tough Book are ridiculously overpriced and underpowered.
Lenovo, and ASUS cut more corners and are not as well-suited for all day EMR use (I have not used them, but looked into them previously. There may be some recent changes, but for the most part, computer companies are chasing the IPAD market now), but could be worthwhile if you had a reasonable deal on one compared to...
Editor's note: Dr. Garfield's extended-length letter can be read here.
06/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: VST Myodynamic (Neil Burrell, DPM)
From: Robert Eells, DPM
I also have experience with the VST. I too have had excellent results in treating neuropathy pain using the VST. I don't know what Chiropractors may be using, as referred to by Dr. Burrell in his post on May 28th. I began using the VST in 2008. Initially, examples were provided showing billing using either attended or unattended e-stim codes. I chose to use the unattended, G 0283, e-stim code in my practice.
After doing some research, I learned that some pain management specialists were treating intractable pain with e-stim and local anesthetic blocks. I decided to try this for myself and began using the unattended e-stim code for the VST treatments along with lidocaine injections to the tibial nerve in PT block fashion. This combination treatment achieved even better results (fewer treatments, faster improvement) than just e-stim alone. It continues to work for my patients in a high percentage of cases.
Disclosure: I have no financial relationship with V-Care.
Robert Eells, DPM, Des Moines, IA, rgeells@gmail.com
05/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Lancing Malusky, DPM
I have been in practice since 1974 and am ABPS Board Certified. When we remodeled in 1986, I installed a central vacuum for our Xanax C02 laser. This quite adequately removes the environmental nail dust. My patients greatly appreciate having mechanical debridement of thick nails. When done with the debridement, we spin the bit in the cold sterile solution, instantly removing remnant debris. Making a DPM feel retro for providing this service is silly. And at 64, I am still very healthy, active, and lung disease free!
Lancing Malusky, DPM, Kettering, OH, lmalusky@woh.rr.com
04/25/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Ivar E. Roth DPM, MPH
If one uses a hygienic clean drill bit for each patient and a vacuum system for the drill, I think that nail debridement would become a safe activity for podiatrists. Am I wrong? I have developed a new nail debridement technique for fungus toenails that is quite effective, utilizing a drill and vacuum system. My hope is to make this new technique available to the profession in the near future. As far as whirlpools, as long as you clean them out with proper technique and cleaning agents, this should not be a problem. As podiatrists, we should be offering our patients the best available treatments, and part of that is filing nails and using whirlpools.
Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
03/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: ABPS Name Change (M. W. Aiken, DPM)
From: Jeff Mennuti, DPM, Charles G. Kissel, DPM
In regard to the name change, it think this is a prudent step. ABPS is also an acronym for the American Board of Plastic Surgery. I believe each specialty should have their own acronym to avoid confusion. This should not be misconstrued for anything other than obtaining a unique, and separately identifiable acronym.
Jeff Mennuti, DPM, Orange City, FL, dr.mennuti@gmail.com
As a long-time residency director and the father of two sons who are currently training to become podiatrists, I have a significant stake in the future of our profession. I understand the concern of our colleagues that we do not wish to lose our unique identity, and agree wholeheartedly that we must continue to demonstrate that we have a skill set that makes us more qualified to treat patients with foot and ankle disorders than any other type of healthcare provider.
Board certification exists in order to credential its members as competent and qualified in their field. The board does not define "who we are," but exists to certify, "what we do." The name change to the American Board of Foot & Ankle Surgery will define us as the ONLY specialty in Foot & Ankle Surgery with such certification. This will be then clearly identified as such to all entities including government, hospitals, the insurance industry, and the public. It defuses the argument that we are podiatrists, certified "only" in "podiatric procedures" and that other specialists are those qualified in the full range of surgical procedures available to the "Foot & Ankle" surgeon.
I hope that the profession acts as one to support this important change. As "podiatrists" we cannot afford to allow internal conflict to impact the future of our specialty. As we move forward, we should do so arm in arm, together.
Charles G. Kissel, DPM, Warren, MI, ckissel@dmc.org
03/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Cost to Podiatry for ICD-10 in 2013 (Bruce Krell, DPM)
From: Harry Goldsmith, DPM
Most experts estimate the cost for implementation of ICD-10-CM within a 3-doctor practice to be somewhere between $40,000 and $80,000. What will drive the cost?
1) Software upgrades – practice management software – not only to include ICD-10, but also retain ICD-9
2) Software upgrades – EMR software – not only to include ICD-10, but also retain ICD-9
3) EMR podiatric-specific documentation upgrades/development (templates, macros, dropdown choices, etc.) to account for higher levels of specificity,...
Editor's note: Dr. Goldsmith's extended-length letter can be read here.
