07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Source for Accu-Mold Substitute (Joan E. Schiller, DPM)
From: Christopher Case
PediPlast® Moldable Podiatric Compound has long been a popular alternative to Accu-Mold for the creation of custom digital devices in less than 5 minutes.
To order, or get more information, contact PediFix or the major industry distributors, including Gill, Moore, and Schein, all of which have PediPlast in stock for immediate delivery.
Christopher Case, PediFix Footcare Company, Christopher.Case@pedifix.com
07/03/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: First Coast Disallows CPT 76942 for Podiatrists
From: Marc Katz, DPM
Here is the link and some of the points that have been issued by First Coast Medicare regarding CPT 76942. Those who scrupulously used this code for a small portion of your patients to guide injections will no longer be able to use the code in pretty much all cases. You can thank our colleagues who use it on every injection in the office. It seems to just be the story of podiatry! And, of course, of all specialties, podiatry is one of the only ones specifically mentioned, "Needle procedures of the foot by podiatry or other specialties. (Most of these interventions are standard office based needle procedures and not special procedures performed on a radiology suite)."
A few other points from the link: "Though MAC J9, based on the low quality of evidence in the peer reviewed literature, could deny many of these billing situations as services not meeting the reasonable and necessary threshold for coverage, there is concern with beneficiary liability. CPT® 76942 is valued in the 220 dollar range, whereas the majority of the office-based procedures outlined above suggest value in a range from 0 to 40 dollars. (This is based on reference value mapping of CPT® codes such as the value assign for CPT® code 76937 Ultrasound guidance for vascular access). In summary, it is the expectation that physicians utilizing ultrasound guidance for standard office based needle procedures will not code separately, or alternatively, bill the unlisted code CPT 76999."
Marc Katz DPM, Tampa, FL, dr_mkatz@yahoo.com
06/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Facility Fees (Tip Sullivan, DPM)
From: Martin V. Sloan, DPM
There is likely no rational explanation for fee discrepancy, just as there is no rationale for other areas of reimbursement. Here's another: Medicare will NOT pay for functional orthotics when medically necessary, yet they WILL pay for accommodative diabetic inserts ANNUALLY when medically necessary. So, over a ten-year period in a diabetic's life, they will pay approximately $2,000 for A5513 (@$200/year) but they WON'T pay $400 for a pair of well-made orthotics that should easily last ten years.
Martin V. Sloan, DPM, Abilene & Rockwall, TX, mvs32154@gmail.com
04/29/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Pete Harvey, DPM
Most digital x-ray systems, whether DR or CR, should be adaptable to your current X-Cell machine. Your costs will probably go up because of software agreements, etc. However, that is usually offset by the convenience of digital.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
12/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Policy for Handguns in a Podiatric Office (Frank Lattarulo, DPM)
From: Philip McKinney, DPM
Policy regarding handguns in the office. You mean for staff or patients? Do you have a problem with guns in your office now? Why is this even an issue? Do you have other amendments to the Constitution that you have issues with? Perhaps, we should get rid of any newspapers or news magazines. No Christmas or Hanukkah seasonal displays?
If an individual comes into the office with a concealed weapon, it is concealed, no one else is going to see it; if they have a permit, it is legal. You're going to deny them their Constitutional rights like what's being done in the city of New York? You think that the individual coming into your office meaning to do you or your staff harm is going to be concerned at all with your “policy”?
I have a gun; many of my patients have guns. I have multiple law enforcement patients who are often seen during duty lunch breaks. Guns in the office are not an issue. In my twenty plus years of practice, I have drawn my gun in the office twice and fired it once. I am responsible for myself, my staff, and any patients in the office. I am not going to allow someone high on meth (common here) to assault me or anyone in my office. Perhaps, you should look more to establishing a policy for those who wish to do harm to those in your office because if you post a “policy” towards guns, the only people who are going to respect it are the law-abiding individuals, not the ones you should be concerned about.
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net
10/30/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Landmark Medicare Changes for Long-Term Care
From: Michael M. Rosenblatt, DPM
There has been a landmark settlement of a class action suit against Medicare regarding long-term care and some beneficiaries who need it, including both at-home care and institutional care. It is too long to explain here, but it might have an impact on long-term care that includes podiatry. An interesting example of this involves one of the plaintiffs, who herself had diabetes, blindness, and an amputation. Prior incidents of refused coverage for podiatry services at home/institution may now be re-opened for payment.
This may be a game changer for at-home/institutional podiatry services, but the exact impact has yet to be determined, since the impact seems mainly on nursing care. For podiatrists who see these patients, you may be asked by some of your patients or their families to re-submit denied claims based upon lack of eligibility. You may also see requests for more podiatry services from people who might otherwise have been excluded. Also unknown is the extent of increased costs to Medicare resulting from these changes.
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
10/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Combination Billing/Collection Service (Ron Werter, DPM)
From: Robert K Hall, DPM
The best way to avoid this dilemma is to use free eligibility sites available or pay sites like checkmedicare.com/Cortex to determine up-front the patient's liability. Then either "attempt" to collect by showing the "patient responsibility" printout OR "Hold" deductibles until met. Co-pay/Co-Ins, if low ($10/20%), may be worth writing off and taking the 80% UCR. High co-pays $40-50 often are in excess of allowables and must be collected at time of service. Just some thoughts in this tightening economy.
Robert K Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net
10/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Vibration Anesthesia Device (Mark K. Johnson, DPM)
From: Scott L. Schulman, DPM, Neil Levin, DPM
We have 3 of them, one for each office. They work reaonably well. Patients generally like them. They still feel something, but it is much less painful than normal. We also have Derma-jets, which work well, but the initial snap bothers some people. Overall, I think they are worthwhile.
Scott L. Schulman, DPM, Indiana Podiatry Group, scottldpm@yahoo.com
Don't waste your money. I purchased two of them and promptly returned them. They are only effective (and barely so) on thin dorsal skin. I went back to good old ethyl chloride.
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com
09/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Retirement Options (Joe Borden, DPM)
From: Michael J. Schneider, DPM
I retired in 2011 at the age of 70 thinking that having all of that "free time" would be great. It was for a while, but I have found that unless you have a serious hobby, there may be a fulfillment issue. It isn't easy to get employment at this stage of life, so I made the decision to work at any price. In my case, it is all "pro bono" at an indigent facility and the Denver Rescue Mission here in Colorado. I will add that it is extremely fulfilling and better yet, I never have to deal with the insurance industry. My advice? If you love our profession and are in good health, keep working.
Michael J. Schneider, DPM, Denver, CO, podiatristoncall@gmail.com
09/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
RE: Retirement Options (Joe Borden, DPM)
From: Art Hatfield, DPM
I just turned 70 in June. I deferred taking my SS until then. I am getting about 40% more than I would be getting if I had taken it at my full retirement age of 65 and 8 months. I know there are different opinions on this subject, but I always felt that I will need that extra 40% more when I am in my 80s than I needed it while still working.
Taking your SS before reaching your full retirement age (for you 66 years of age) will cause your benefits to be reduced to $1 for each $2 you earn if you are still working. Unless you have a very short life expectancy, wait until are at least your full retirement age. You really need to talk to a SS Administration officer or read, "What You Need to Know When You Get Retirement or Survivors Benefits," available from the SS Admin. It's probably also available on line. Also, remember you probably won't qualify for Medicare until you are 65.
Art Hatfield, DPM, Long Beach, CA, Afootjob@juno.com
08/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Practice Broker (Name Withheld)
From: J Langford, DPM
If you are insured by PICA, I believe you can call them, and they can help with the appraisal of your practice.
J Langford, DPM, Memphis, TN, jlangforddpm@bellsouth.net
08/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Classification of Diabetes
From: Neil A Burrell, DPM
I realize this might seem petty, but as the foot experts and as the foot experts in diabetes, many podiatrists have trouble with the classification of diabetes. I read many times on PM News podiatrists who misuse classification of Type 1 and Type 2. The old terms were juvenile diabetes and adult diabetes. These were changed to IDDM, insulin dependent diabetes mellitus and NIIDM, non-insulin dependent diabetes mellitus.
This was confusing as well, so the terms were changed to Type 1 and Type 2. You do not change types once diagnosed. Think of the old types as well as the word "dependent". Type 1 are dependent on insulin. Without insulin, they would die. Type 2 may take insulin, but this does not make them a Type 1 just because they take insulin. They are NOT dependent on insulin to live. They use insulin to help control their diabetes.
Remember that 90 % of those with diabetes have Type 2 and 10% have Type 1. Type 1 is mostly diagnosed in children (average age 9-12), while Type 2 is normally found in adults who are overweight. Type 1 is a quick onset while Type 2 is a gradual onset. If we are going to be the experts in the diabetic foot, let's use acceptable terms like our fellow healthcare workers. I do see a lot of misuse by MDs as well.
Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com
08/01/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Affordable Care Act (Obamacare)
From: Paul Jones, DPM
My brother in Oklahoma is insured and had some dental work done. His insurance paid the claim, but the payment was not sent to the dentist providing the service. My brother is divorced, with children. The new law now requires that the payment not be paid to the doctor, but to some type of holding account that evaluates whether or not he is outstanding in child support. If my brother were outstanding in this debt, the money would be used towards the debt of the outstanding child support first, and then, maybe, the dentist will be paid the difference in the amount of the original remaining insurance payment. Has anyone experienced this yet?
Paul Jones, DPM, Spokane Valley, WA, instepfootandankle@gmail.com
07/31/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Independent Auditor for Billing Company (Name Withheld)
From: Bob Hatcher, DPM
You might consider Triangle Medical Mgmt at 919-632-8994.
Disclosure: TMM is run by my wife who has had 35 years of experience in all types of medical insurance billing and coding, including family practice, urology, neurology, and neurosurgery.
Bob Hatcher, DPM, Raleigh, NC, boboffice@nc.rr.com
07/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Affordable Care Act (Obamacare) Perk (Richard Rettig, DPM)
From: Ken Hatch, DPM,
I recently retired. My Medicare supplemental premium is $151 monthly. My wife, younger than me, pays $1,056 monthly (BC/BS CAREFIRST of Maryland). This is a $100 monthly premium increase. We both use the same insurer. She got nothing back because her carrier "Met or exceeded the federal payout standard." I got $ 40.35 back for mu last year's premium on my Medicare supplemental policy, same carrier. I'll wave my forty buck rebate and hope that Congress dumps OBAMACARE!
Ken Hatch, DPM, Annapolis, MD, KLHDOC@aol.com
I have a difficult time believing what I am reading. If a company is forced to spend millions of dollars on themselves or give it away and they just “can’t make that happen”, we would be reading about the firing of a major CEO.
Presupposing it is the case, that insurance companies are now restrained by a government mandate to limit profits, it is amazing to me that anyone would be in favor of this. The easy out is to dismiss the possible...
Editor's Note: Dr. Purdy's extended-length letter can be read here.
07/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Affordable Care Act (Obamacare) Perk
From: Richard Rettig, DPM
My personal health insurance is with a major health insurance company through my wife's employment. Today, we received a letter titled "Notice of Health Insurance Premium Rebate."
It states they are REQUIRED by the Affordable Care Act to apply at least 85% of the health care premiums received towards actual medical care (and not 'profit', advertising, salaries, etc.). Even knowing they would be held to this number, they still missed it by 1.5% and have to refund the excess premium either as cash to us or towards reducing next year's premium. It is called the "Medical Loss Ratio Rule." In previous years, they would have kept this. 1.5% isn't that much, but I bet that in previous years, when there was no mandate to hit the 85% mark, that the number would have been much higher.
You may be for or against the ACA concept, but there are some goodies in those 2801 pages! You can be assured I never got a letter like this in the past. I am glad that the insurance companies are being held accountable for their excess premiums.
Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com
07/26/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Best Laser for Onychomycosis (Greg Teles, DPM)
From: Dennis Shavelson, DPM
I would like to add one brand that I think should be avoided by podiatrists. It is Fotona Lasers. A year ago, I purchased one of their lasers along with a Zimmer Chiller that was supposed to reduce pain. The Dr. and his nurse wife who import these lasers from Europe promised excellent support, but had no pro-active contact with me in all this time. They never upgraded my system or informed me of important marketing information. This meant lost income for me.
The unit often produced pain, even for mycotic nails, and when I confronted them with my displeasure and the fact that they promised a pain-free experience most of the time, I was berated with defensive reactions. They then they stopped answering my calls.
Dennis Shavelson, DPM, NY, NY, DrSha@foothelpers.com
07/25/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Artificial Toenail Innovation/Successes (Eric Hart, DPM)
From: Janet McCormick, MS
There is no such thing as a permanent "fake" nail and, of course, there should not be such a thing. At best, they are temporary and this should be inherent knowledge when considering applying one. The patient should be fully informed of this, the importance of home care and of follow-up care. The retention time of the artificial/prosthetic/fake nail is according to several factors:
1) The expertise of the person who applies the product has the most effect on retention.
2) The amount of nail plate - or lack there of - is important for retention. A small amount of nail plate, however - no matter the configuration - can retain...
Editor's note: Ms. McCormick's extended-length letter can be read here.
07/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Best Laser for Onychomycosis (Greg Teles, DPM)
From: Robert A. Kornfeld, DPM
Lasers are proving themselves to be better and better at dealing with the presenting symptoms in the nail bed and plate. But please, please do not be fooled into believing that the laser is a reliable permanent solution. This is not a purely local phenomenon. It is systemic and has specific causes (mechanisms) that must be addressed to effect a long-term cure. I have much to share with this profession and I patiently await your embrace.
Robert A. Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
07/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: "Press Ganey" Surveys (Marjorie C. Ravitz, DPM)
From: Pam Thompson
Press-Ganey is a patient satisfaction survey vendor used by almost 40% of the hospitals in the U.S. The hospitals sometimes try to grade associated physicians using P-G surveys. Press Ganey was the vendor used in the Bridges to Excellence (BtE) program and the Integrated Healthcare Association’s (IHA) P4P initiative in California (7 million enrollees, 215 physician groups with 45,000 doctors, most organized in IPAs) several years ago, sending surveys to patients asking them about their impressions of facilities, staff, and physicians.
It was my understanding at the time that the patient satisfaction surveys used during those P4P studies by IHA and BtE (CMS was heavily involved, BTW) were to provide 40% of a physician's "grade", which was to be used to mete out performance bonuses from payers, and later to determine reimbursement rates for CMS and most commercial payers. 20% of the physician's grade was determined by meeting technical metrics (read EHR), and the last 40% was determined by the physician's adherence to clinical guidelines (whose, I don't recall).
Press Ganey remains the largest patient satisfaction vendor in the U.S., as far as I know. Not surprisingly, there have been recent studies showing that...
Editor's note: Ms. Thompson's extended-length letter can be read here.
06/23/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Source for Local Anesthetics (Peter Smith, DPM)
From: Jeffrey Kass, DPM, Philbert Kuo, DPM
I had the same problem with Moore. I called Gill podiatry and got my lidocaine within a week.
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com
Try Henry Schein or Surgical Supply Service. You could also try to purchase through your local hospital's outpatient pharmacy. If they are out of lidocaine 1% then ask for lidocaine 2%. This is a nationwide problem.
Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net
06/20/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Snap Fixation Pins (Mark H. Sugar, DPM)
From: Charles Morelli, DPM, Tip Sullivan, DPM
Wright Medical has a 2.0 snap off screw, and I believe Integra makes one also.
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com
Here is a suggestion regarding “snap off” wires. Make your own. Back in 1985, Dr. Nathan Schwartz had us scut monkeys taking threaded 0.045 in K-wires and 0.062 in threaded wires. Measure them at 16, 18, 20 and 22mm, and mark them with a skin marker. Then take a jeweler's file and file a notch at each mark about < 50% through the wire. There you go — flash them and you have a fancy snap-off wire. You can use the skin marker mark to help you determine depth as you put the wire in, although nowadays you could use a “C” arm with comparable ease.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net
06/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Snap Fixation Pins (Mark H. Sugar, DPM)
From: Ed Davis, DPM
Dr. Sugar requested a substitute for the snap fixation pins. I like the Tornier Nexfix Compression Pins: (tornier-us.com/upper/hand/hantra001/index.php). This product has been marketed to hand surgeons, but is ideal for all small bone work. This pin has a variable pitch thread with better compression than standard threaded K-wires. They need to be cut off at the bone surface with a pin cutter. The pin cutter supplied by the maufacturer of the product allows one to cut the pins almost flush with the surface.
Disclosure: I have no financial relationship with Tornier.
Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net
06/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: "Unified" Post-Graduate Training
From: Tip Sullivan, DPM
The different opinions on board certification, residency programs, should-a, would-a, could-a ideas have been interesting reading. Many of them, I agree with to some extent, and some I disagree with— but all of them are interesting and worthy of consideration and debate by our representatives to the powers who make changes.
I am no podiatric politician, and that is what this feels like to me—politics. I personally chose 3 years of post-grad training way back in the 1980s because I got lucky and landed a 2-year residency and was blessed by getting offered a fellowship by someone who had a vision to improve our education (Larry Oloff, DPM). There was no political influence in it—It was real simple –IMPROVE OUR EDUCATION SO THAT WE CAN DO A BETTER JOB.
In 1986, the residency program (CCPM) was easily comparable to...
Editor's note: Dr. Sullivan's extended-length letter can be read here.
06/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
RE: "Unified" Post-Graduate Training (Charles M Lombardi, DPM)
From: Michael M. Rosenblatt, DPM
The three-year residency “requirement” for podiatrists is a direct result of the political position we are in with allopathic medicine. Whenever MD competitors (primarily orthopedists) attack podiatry, it is always in the same guise - our training. The lengthy residency (and ABPS certification) some of us have taken is a reaction to that criticism, and the other, that our training is “sporadic” and unreliable.
In fact, most podiatry schools have taken on a centralized philosophy of didactic training in basic sciences. Clinical training has been harder to pin down, and there are still variations in that target between schools. But there are also wide gradations among our own non-surgical competitors’ training, specifically nurses and physician assistants. Whenever we have political infighting, I think it helps...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
