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05/15/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Edmond F. Mertzenich, DPM, MBA
After reading all the different responses to this particular posting, maybe what needs to be done is have either our podiatry colleges do research on this subject to develop standards or have the APMA create a taskforce to improve standards on this practice. This would create uniform national standards that podiatrists should meet for sanitation and air quality. Patients and providers will have a better healthcare environment.
Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com
Other messages in this thread:
07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Setting the Record Straight on Debridment of Calluses in Diabetics (Alan Sherman, DPM)
From: David Armstrong, DPM, MD, PhD
Just to let you know, we responded directly to Dr. Bernstein months ago directly in the journal Diabetes Care.
David Armstrong, DPM, MD, PhD, Tucson, AZ, Armstrong@usa.net
06/04/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Medicare Calling Patients
From: Name Withheld (MA), Name Withheld (NY)
I had a very similar conversation with one of my patients a couple of weeks ago. She informed me that Medicare called her and asked her why she sees me. I find this very troubling as well.
Name Withheld (MA)
A colleague of mine had the same issue, but it progressed from simple questioning to audits, to now an indictment. Be careful, because it seems like a fishing expedition on the part of Medicare.
Name Withheld (NY)
05/10/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Letter to Gov. Christie About ESWT Coverage
From: William A Sachs, DPM
I recently had a former patient return to see me. I had performed ESWT on her 10 years ago. She began to tell me how great the procedure had been and that she has been pain-free for all these years. She remarked that she heard "it's not covered anymore" and she's so happy she was able to have it covered at that time because it really "made a difference" in her life. It prompted me to write this letter to Governor Christie. My hope is that others will take the time to write a letter to their government officials in the hope that there may be some transparency and maybe some action taken to allow us to better serve our patients.
Dear Governor Christie, ....
Editor's note: Dr. Sachs' extended-length letter can be read here.
05/06/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Purchasing a Digital X-Ray System (Raymond Posa)
From: Michael L. Brody, DPM
Mr. Posa goes into great length to describe the differences between CR and DR, and claims that CR is not true digital radiology. Scholarly papers refer to CR - computed radiography as digital radiography. The only place I have seen claims that CR is not true digital radiography is in literature by DR manufacturers.
Please remember the POWER of digital radiology is not in the image capture, but...
Editor's note: Dr. Brody's extended-length letter can be read here.
05/02/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatry's Secret Problem (Victor Marks, DPM, MPH)
From: Barry Mullen, DPM
There are a plethora of medical conditions that can and should be added to Dr. Marks' dementia list for at-risk foot care coverage. These include, but are not limited to, blindness (and a multitude of other physical and mental conditions that preclude patients from safely rendering self foot care), immuno-suppression from ANY cause, anticoagulant therapy, and DM, to name but just a few.
That said, be careful what you wish for. Cash is always a preferred compensation for medically needed, rendered podiatric services; if the...
Editor's note: Dr. Mullen's extended-length letter can be read here.
04/29/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Replacement for Fabco (Paul Taylor, DPM)
From: R.D.Teitelbaum, DPM
I have used a self-adherent gauze called Stat-Wrap, that originally was sold by several vendors, including Miami Bandages Plus. It came in several sizes--- 1" and 2" were my favorites. Recently, only Henry Schein carries it under the German manufacturer's brand name -'Haftelast'. Why this seems to be the only self-adherent dressing gauze on planet Earth is an interesting question in itself. It is essential to my practice.
R.D.Teitelbaum, DPM, Naples, FL, Mfvandange@aol.com
04/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: TRAKnet Hires Its Original Computer Architect
From: Michael J Felicetta, DPM
Bravo to Nemo Tech for getting the heart and soul of podiatry software back with the profession that appreciates him, and additional kudos to Nemo Tech for establishing a singular podiatry-friendly EHR vendor. It has always been necessary for podiatric medicine to fend for ourselves in the healthcare field, and our niche has been bolstered by the events at Biomedix-TRAKnet's recent upheaval.
Michael J Felicetta, DPM, Toms River, NJ, DrMFoot@aol.com
03/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Pre-Authorization for Imaging (Robert Steinberg, DPM)
From: Keith L. Gurnick, DPM
Rather than trying to "get even" with an insurance company, I am requesting that patients get involved as an advocate in their own healthcare, as I too have often been asked to do. When I ask the patient to find out if a pre-certification or pre-authorization is required prior to obtaining an outside imaging study that I have requested, the patient becomes a better patient and learns exactly how their health insurance works (or doesn't work).
Usually, the patient makes the call right away, sometimes on their cell phone while they are still in the office because they want to have the test done ASAP. There is nothing wrong with having the patients do some of their own leg (foot) work. When authorizations are in fact required, my office also gets it done usually the same day, because I too want the test done ASAP so I can get the results and move forward with treatment plans for the patient.
Keith L. Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
12/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Source for Urea Liquid or Gel (Steve Block, DPM)
From: Susan Papp-Mlodzienski, DPM, George Jacobson, DPM
Kera- 42 (42% Urea cream) Clinical Therapeutic Solutions (ctsrx.com) - For in-office it dispenses for approximately $25, retail.
Susan Papp-Mlodzienski, DPM, Philadelphia, PA, papp.mlodz@comcast.net
Look up Stratus Pharm. Inc. Miami, FL. They have a 15cc 40% gel with an applicator brush. They also have urea cream in all strengths.
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com
11/01/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Laser for Plantar Fasciitis (Susan Papp-Mlodzienski, DPM)
From: David Zuckerman, DPM
One of the lasers that I use for treating tendinopathy diseases is the Diowave 10, 15, or 30 watt laser. There are others. You can use a 10 watt laser, but the higher wattage in the laser, the faster the onset and increased tissue penetration. This is called peak power.
A 980 wavelength is very important to ensure deep tissue penetration without getting photons to the damaged tissue. There will be little to no effect. This is why power is important as well as wavelength. This is part of the therapeutic window for tissue penetration. The concise
principle...
Editor's note: Dr. Zuckerman's extended-length letter can be read here.
10/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Combination Billing/Collection Service (Ron Werter, DPM)
From: Brock Rasmussen, DPM, MBA
We found ourselves in a similar situation as Dr. Werter. With rising deductibles and more patient responsibility, we found more “excuses” as to why patients couldn’t pay. We also found more and more patients not being willing or able to pay for their surgeries up front in a lump sum and then rarely paying us on time afterwards.
We found a lot of it had to do with our lack of structure on how we collect. We used to send large bills to a collection agency, but because of these issues, we decided to create our own in-house financing program. We invested a significant amount of money to be sure we did it legally and correctly, and now our billing people handle everything with coding and insurance, and our finance person handles all...
Editor's note: Dr. Rasmussen's extended-length letter appears here.
10/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2A
RE: Vibration Anesthesia Device (Christopher Huerta)
From: Peter Smith, DPM, Steven I. Gubernick, DPM
Thank you to Mr. Huerta for the clarification. As a satisfied podiatrist/user of the device, I was shocked by the arrogance and absoluteness of Dr. Ricketti’s statement. Now it makes much more sense.
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu
Having known James Ricketti, DPM for 20 years, I find his ethics beyond reproach. While the Vibration Anesthesia Device made by the company Christopher Huerta represents may serve a similar purpose as the products Dr. Ricketti invented, I believe they are clearly not the same products, nor are they intended for the same patient segments, hence Dr. Ricketti was under no obligation to disclose a conflict of interest because none exists.
Steven I. Gubernick, DPM, MS, Lawrenceville, NJ, sgubernick@imscg.com
08/31/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Microphones for Dragon Medical 11 (David Kahan, DPM)
From: Mark K. Johnson, DPM
I have been using Dragon Naturally Speaking since 2002; currently DNS Medical 11. Close-miking seems to work better for us; I utilize the Dictaphone Power Mic II with programmable buttons on my laptop in a side room with EMR; in my private office either the Sennheiser ME3 headset or the Sennheiser MD431 mounted microphone give excellent results with good enunciation and "spacing" between words when dictating. I have used Knowbrainer.com in addition to EMicrophones online.
Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net
08/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: 25,000 Hours (Hal Ornstein, DPM)
From: Art Gudeon, DPM, Gayle S. Johnson
I'd like to add my thanks to TWO giants of the profession...both Barry Block AND Hal Ornstein have given so much of their lives, and made podiatric life for all of us so much more interesting, fruitful, and FUN. It's probably why I'm still enjoying my "work" after 52 years... so far. Keep up the good work guys, I don't want to retire!
Art Gudeon, DPM, Rego Park, NY, afootdoc@hotmail.com
Thank you, Barry, for investing so much of your time and yourself to bring PM News to us all. I doubt that many people understand what it takes to produce even a small fraction of what you have done. It is inspiring, and greatly appreciated. And thanks to Hal for bringing it to our attention.
Gayle S. Johnson, Edmonds, WA, Gayle S. Johnson
08/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: APMA "National" and Post-Convention Greenbrier Seminar
From: Arthur Gudeon, DPM
My roommate for the "National" had to drop out, so if anyone is interested in sharing a room to split expenses, I'm registered for a double room from Wednesday night, August 15th through Sunday August 19th. Also, I'm registered for the post-convention Coding Seminar at the Greenbrier, and due to a home health situation will not be able to attend. The registration fee was $395, and I'd transfer it for 1/2 the price or best offer, whichever comes in first.
Arthur Gudeon, DPM, Rego Park, NY, afootdoc@hotmail.com
08/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: Affordable Care Act (Obamacare) Perk (Jon Purdy, DPM)
From: Joel Lang, DPM
Let’s not weep too long or too deeply for the ‘oppressed’ healthcare industry. Over the past 3 years, their stock prices have soared (ex: United Health Care $20-$55, Humana $32-$75, HealthCare REIT $30-$60, etc.). In addition, there is no correlation between dropping plastic surgery rates (if that’s actually true) and healthcare premiums which have also soared. The salaries of health corporate executives have progressively increased, while more care is being denied and medical fees are being cut. The Affordable Care Act has multiple benefits for the general public.
*Children will be covered under their parents' insurance to age 26.
*Children under 19 cannot be denied coverage for pre-existing conditions.
*Lifetime benefit limits have been eliminated. Companies can’t cancel...
Editor's Note: Dr. Lang's extended-length letter can be read here.
08/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: Affordable Care Act (Obamacare) Perk (Brian Kiel, DPM)
From: Jon Purdy, DPM
I’m hoping the world I live in is the same as the one that was founded in 1776, although that certainly seems to be changing. My hope is that I live in a country where capitalism, the economic force that made the poor of this country the richest in the world, still reigns as the purveyor of prosperity.
Private companies in the United States are free to make as much profit as they can, pay whomever what salary they want, and deny any services in the product they sell. If the people paying for the policies don’t drop them for another insurance company, or the healthcare providers keep taking that insurance, then they have been given our approval.
Since doctors are still free to choose which patients they see and what insurances they accept, I would think one would be hard pressed to blame their success or failure on those insurers. Insurance companies can’t decrease your profits; you have to let them. If you don’t get paid what you feel you deserve, then stop taking the insurance. Do you see dentists or plastic surgeons complaining about insurance? If the so-called Affordable Care Act is so “affordable”, exactly why is the president giving out exemptions? I think you may find this is a force that actually will decrease your profits without your say so.
Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com
07/31/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Affordable Care Act (Obamacare) Perk (Brian Kiel, DPM)
From: James E. Rogers, DPM
I am in total agreement with Dr. Kiel. I am as busy as I have ever been, yet , every year my gross income declines. I am sure that healthcare executives don't see a decline in their salaries!
James E. Rogers, DPM, Nashville, TN, drjimbob@comcast.net
07/30/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Affordable Care Act (Obamacare) Perk (Jon Purdy, DPM)
From: Brian Kiel, DPM
I don't know what world Dr. Purdy lives in but my "profits" have not only been limited but significantly reduced, not just by government, but even more so by the private, profit-making insurance companies for which Dr. Purdy seems to have such empathy. Their profits continue to explode and their upper management continues to draw multi-million dollar salaries while our fees are continuously reduced. Please, save your tears for those individuals who will be helped by the Affordable Care Act.
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
07/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
RE: Best Laser for Onychomycosis (Greg Teles, DPM)
From: J. Michael Lunsford, DPM
I have utilized lasers in my practice since 1982. Onychomycosis treatment options have traditionally been limited to oral meds, topicals, or surgical procedures. I am extremely pleased to note that my experience with the HyperBlue 1530 laser system I purchased a little over a year ago has exceeded my expectations. I researched a total of 5 systems over a 2 year period and consistently found the HyperBlue superior to all others in both success and support. Before you purchase a system, give them a long hard look, and I think you will find they are the correct choice.
J. Michael Lunsford, DPM, Houston, TX, jmldpm1@aol.com
07/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2A
RE: Fotona Laser for Onychomycosis (Dennis Shavelson, DPM)
From: Joseph F Campbell, DPM, Robert G. Parker, DPM
I'm in total disagreement with Dr. Shavelson. We purchased a Fotona Laser from that same person over 2 years ago. We could not be happier with the laser as well as the support that we get from them! Of all the equipment over the years I have purchased, never has anyone been as responsive as they have been! They will call us or e-mail us to this day with any suggestions that may produce a better result. Even with marketing, they give suggestions. This is 2 years after they have been paid! How much better can you get? I would never hesitate to buy again from them.
Joseph F Campbell, DPM, N Ft Myers, FL, baron767pc@earthlink.net
I had the first laser in Houston for the treatment of onychomycosis and have now advanced to my third and best laser, the Fotona. I strongly disagree with Dr. Shavelson's report on Fotona and am very puzzled as to how he can be critical of one of the most professional and knowledgeable presentation and training one could receive in this area. I have had my Fotona now for over two years and found Robin Sult, RN, an international speaker and instructor in Fotona technology, always responsive to my phone calls and e-mails and available for help when we needed it.
It is disheartening to hear a colleague speak disparagingly of Robin and Fotona. I have several colleagues who feel as I do, that this instrument, produced by a company in the laser business for I believe now over forty-five years, has moved us years ahead with their patented variable square pulsed laser delivering equal 5mm homogenous wavelength, where the others, though effective, are Gausian hot center-cool pheriphery delivered.
Robert G. Parker, DPM, Houston, TX, drparker1@me.com
07/27/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Fotona Laser for Onychomycosis (Dennis Shavelson, DPM)
From: Chris Milkie, DPM, Bela Pandit, DPM
I disagree with Dr. Shavelson's remarks regarding the Fotona laser. We have had very good results with it and excellent customer service. It has also been minimally uncomfortable for most patients. We are also pleased that Fotona has been FDA-approved. I recommend it without hesitation!
Chris Milkie, DPM, Milwaukee, WI, cmilkie@wi.rr.com
I have been using the Fotona Laser for almost two years now and have had great results. I have only positive things to say about the Fotona laser and its representatives that Dr. Shavelson mentions. I personally receive emails regularly for follow-up, and they are always available on the phone. In fact, the representative even sent me a 17 year old patient who drove two hours for laser treatment for a nail that was misdiagnosed as cancerous when, it fact, it was a fungal and yeast infection. The Fotona laser cleared up the nail immediately.
Never once was the laser promised to be pain-free, and to be honest, the pain is very minimal. In fact, during training, it was taught that the patient would have some discomfort. All the other reputable lasers I have had a chance to test all caused pain as well. I am not sure what personally happened in Dr. Shavelson's experience, but don't rule out a great laser due to one review. And, as with any treatment for onychomycosis, the patient needs to initiate and maintain lifestyle changes (i.e. not walking barefoot, replacing shoes, maintaining hygiene, and treating the tinea pedis, etc.) to see the best results.
Bela Pandit, DPM, Chicago, IL, bela_pandit@hotmail.com
07/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Dr. Markinson's Commencement Speech at the NW Podiatric Residency Graduation (Michael M. Rosenblatt, DPM)
From: Michael Lawrence, DPM
My regard for Dr. Bryan Markinson continues to skyrocket. Besides his obvious clinical expertise, he has, in my opinion, become a voice of reason. His wisdom as far as where our profession is currently and where it should go, is profound. He's kind of like the Walter Cronkite of podiatry. Every time he speaks, I listen intently and learn. His graduation address published in this forum is eloquent, yet straight forward, refreshingly so but expected from the source. I really don't know of a current equal, and I truly appreciate his insight.
Michael Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com
06/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Unified Post-Graduate Training
From: Jack A. Reingold, DPM
I have read all of the recent threads concerning our post-graduate training. It really is not that complicated. No one can have too much training. Just because your residency ends, it does not mean that your training ends. In fact, it is really only starting. As the expertise of our profession grows, it is hard to acquire all the knowledge needed to be the best foot and ankle doc in just 3 years. There are fellowships, workshops, lectures, and more for all of us, at all levels of our careers. Also, not everyone has to have the same skills set. One just needs to be the best in the area one wishes to function in, be it trauma reconstruction, wound care, or biomechanics. Knowledge is power.
Jack A. Reingold, DPM, Solana Beach, CAfootdoc@san.rr.com
06/15/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2A
RE: Unified Post-Graduate Training (Bryan Markinson, DPM)
From: David Gurvis, DPM, Ron Raducanu, DPM
Kudos to Dr. Markinson for calling it for how it was and is. I am board certified, and have watched the evolution of the same problems Dr. Markinson enumerates. There was a concerted effort to convince all hospitals that the certification (italics mine) was the only method of showing competency.
Bryan's history is accurate. The future can change, but only when we all get along and stop the two-tier mentality.
David Gurvis, DPM, Avon, IN, deg1@comcast.net
I definitely have seen this as well, and agree with Bryan 100%. I have also seen another scenario played out as well where now, one of the elder statesmen of podiatry in the community holds a relatively powerful position in the hospital system he have been working in for 25 years. All of a sudden, the bylaws change to only allow very well trained and RRA-certified only practitioners in the community get privileges at that hospital. At the same time, they make sure to include verbiage in the bylaws to protect those who have held certain privileges "grandfather" themselves into maintaining their current privileges. In some communities, there are no such trained new practitioners except one or two, and guess who they work with?
I don't agree with any of these scenarios, which is why I've been speaking about a unified board and unified certification for ALL of us since I came out of residency in 2002.
Ron Raducanu, DPM, Philadelphia, PA, kidsfeet@gmail.com
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