01/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
From: Jack Sasiene, DPM
Dr. Baum gives a good account of what has happened to the practice of medicine over the last 30 years. He nicely states how we have all become contract labor for insurance companies, making less and less while they still are very profitable. He correctly observes, "it doesn't look promising for the healthcare provider."
What I fail to understand is, why is it so hard for us to continue the thought process? We need to take back our profession by not working for insurance companies. I don't mean a few docs; it must be 50% of them to be effective. If not, we will continue to be strangled...slowly, very slowly.
Facts: Our APMA spends our money to fight to get us included in Medicaid as "doctors"....why? "Effective January 1, 2012 Texas Medicaid will no longer pay for...
Editor's note: Dr. Sasiene's extended-length letter can be
read here.
01/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Insurance Company Controls (Dennis Shavelson, DPM)
From: Robert Kornfeld, DPM
Dr. Shavelson's points hit the bull's eye. The ripple effect of insurance companies controlling the standard of care is just gaining momentum. Dr. Lavery fools himself when he thinks that "proving" our protocols to insurance companies will make a difference in coverage. To be quite blunt, they look at what costs them the most money and then look for ways to wrangle out of being responsible to pay. I will admit that I may have a more cautious and far less trusting view than most, but I also know what we are up against and am not living in a world of denial.
The movement in EBM plays right into the folly. The truth is, there is almost nothing that stands up to...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
01/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Medicaid Change of Orthotics in NY (Barry Mullen, DPM)
From: Dennis Shavelson, DPM
Dr. Mullen is accurate about being in-network and being bound by contracts. When confronted with this exact situation, I successfully defended my evaluation, casting, prescription, and the eventual device I was representing.
My fee is based upon my custom diagnosis, treatment plan, the custom orthotic I generate, my ancillary program, and its monitoring. My analogy would be that whether I use wet films or digital ones, my fee is for my reading of an x-ray. We have allowed biomechanics to become a DME code and not a CPT code. In my analogy, when we bill 73620, we are getting paid for our expertise and not the film or developing process. Perhaps someday our code will be a technical component to biomechanical cases (L3000-TC) with an appropriate fee. Let the lab bill L3000 for our Rx.
Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com
01/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Medicaid Change for Orthotics in NY (Barry Mullen, DPM)
From: Nicholas D'angelo, DPM
The analogy of the two medications was made to stress my point that when one writes an Rx for Cipro, he knows exactly what the patient will receive from the pharmacy...Cipro. When writing an RX for custom-made orthotics, you may not be getting exactly what you intended. That would be the connection.
Secondly, I never assumed in my post that the vendor's product was inferior. I merely stated that...
Editor's note: Dr. D'angelo's extended-length letter can be read here.
01/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Medicaid Change for Orthotics in NY (Alan Silverstein, DPM)
From: Paul Kruper, DPM
In New York, orthotic Medicaid coverage for podiatry-supplied devices is eliminated. One of my patients who needs hammertoe surgery had coverage denied because her insurance does not cover "weak feet, flat feet, fallen arches, corns, calluses or deformed toes." In a sentence of a dozen words, coverage for a large part of my practice is gone. If we had allopathic licenses, the loss of coverage for these services would generate a yawn. Do you think an MD cares there is no coverage for orthotics? To those who state podiatry would degenerate if we became allopathic doctors, I say the loss of insurance coverage has already accomplished the loss of our ability to practice podiatry.
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com
01/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Medicaid Change for Orthotics in NY (Alan Silverstein, DPM)
From: Nicholas D'angelo, DPM
One is never obligated to write a prescription, especially if you feel that the prescription will not be filled as you intended. Educate your patients on the necessity of performing the services yourself, and the benefits of doing so. If you ultimately write the prescription, be sure to evaluate the final product. If it does not meet your standards, have patients keep going back with the inferior product until they receive a satisfactory product.
Have patients become their own advocates and suggest that they appeal to their insurance plans. Always keep in mind that ultimately, you as the podiatrist, are responsible for the outcome, although you did not provide the custom orthotic. Would one give a prescription for Cipro if the pharmacy provided Naprosyn instead?
Nicholas D'angelo, DPM, Brooklyn, NY, skitoast@aol.com
12/23/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Standard of Care - Neuromas
From: Dr. Michael B. DeBrule
I have used U.S.-guided sclerosing alcohol injections for neuromas in my clinic. Although Dr. Dockery describes good outcomes without sonographic guidance, Espinosa in JFAS (ncbi.nlm.nih.gov/pubmed/21733418) found sclerosing injections without guidance were not helpful (mirrors my experience).
In addition to the studies mentioned by Dr. Davis, a European study by Fanucci, et al. found total or partial relief in 90% of patients using U.S.-guided technique (ncbi.nlm.nih.gov/pubmed/14531002). We are still lacking a double-blinded placebo controlled study.
I know of no studies investigating radiofrequency ablation for neuromas, but recommend this technique as well. Ablation has been successful for heel pain and should work well for other nerve entrapment syndromes of the foot and might be more patient-friendly (doesn’t need to be repeated four times). Landsman, et al. have a double-blinded, placebo-controlled study coming out soon for heel pain.
Michael B. DeBrule, DPM, Marshall, MN, Dr.DeBrule@InnovativeFootCare.com
10/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Stay Away from Trimming Toenails (Peter Vannucchi, DPM)
From: Robert Bijak, DPM, Dennis Shavelson, DPM
I think Dr. Vannuccii is getting a bad rap. My dentist doesn't clean teeth. That doesn't mean he hates dentistry or has a big ego. It's simply a matter of delegation of duties beneath your skill set. There's nothing wrong with utilizing your time or skills to your best advantage. And, I do believe it makes the dentist look more like an authority when he just comes in after the cleaning to do an oral cancer check and look for other pathology. There is no particular glory in cutting a toenail or grinding an arch support. Be a doctor and delegate, and then you'll get respect.
Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com
When I was the DPM at Memorial Sloan Kettering Cancer Hospital in NYC, I eagerly attended patients who were there for two months or more. They were tired, weak, and suffering the ill-effects of chemo; most of them were dying. They and their families were so grateful when I “trimmed” their toenails, relieved an ingrown nail, or a small infection. I knew I had given them fuel to fight on. I saw smiles on their faces and sensed joy in their hearts as if I had just repaired their clubfoot. I gave them dignity and comfort as only a skilled doctor could do.
My memories of what I did for those patients are just as fervent as the ones I have after seeing my residents put the last stitch on a triple arthrodesis. Those toenail trimmings, which didn’t pay for my time, as well as many other services that I perform will someday get me into heaven. Dr. Vannucci’s stern position puts one more nail into the coffin of the profession I so love.
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
09/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Support DPM Candidates for Congress
From: Marc Garfield, DPM
First of all, I intentionally left Dr. Rogers' name and the quote out of my post, which was then later “clarified” by PM News. My point is: that until, I hear what a candidate is proposing and how they propose to enact that legislatively, we should curtail a rallying cry to elect anyone regardless of how you may identify with them. I do not feel it was necessary to name an individual to make that point.
Secondly, I have not expressed my opinions about public policy which many of you are now assuming incorrectly. So, rather than have you all speak for me. I’ll speak for myself. We do not have a free market system in medicine now. We cannot politically remove the government from medicine, residency training, or healthcare policy. Our present system will hit a breaking point...
Editor's Note: Dr. Garfield's extended-length letter can be read here.
09/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Midmark Footrest Slider Repair (Justin Sussner, DPM)
From: J. Ressler, DPM
If you are experiencing a loud metal on metal rubbing noise and the foot section of the chair extends abruptly when minor pressure is applied, it is probably a worn threaded rod that your foot adjustment handle engages on. A quick and easy fix would be to simply go under the foot section of your chair and turn this threaded rod 180 degrees. This will position the unused part of the threaded rod to be in position to engage on the foot adjustment handle.
I think you can even turn the rod with channel lock or vice grip pliers without loosening the end nuts on each side of the threaded rod. If you do turn the rod without loosening the nuts first, grab onto it at either end but not in the middle. Make your repair easier by raising up and tilting back the chair first.
J. Ressler, DPM, Lauderhill/Delray, FL, redwingcrzy@aol.com
08/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Dragon Medical Practice Edition Version 11 Coming in September (Larry Kasova, DPM)
From: Robert Kuvent, DPM
I have been a Dragon user for at least 12-14 years. I currently use Medical v 10. I have used medical and nonmedical versions. I do not think the Medical version is worth the outrageous differential. It still needs to be taught podiatry terminology as well as drug names and medical conditions, just like the regular version. Also, the error rate is no different. Save your money.
Robert Kuvent, DPM, Chandler, AZ, FtFixr@gmail.com
08/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3 (CLOSED)
RE: MD Logic (Joe Borden, DPM)
From: Raymond F. Posa, MBA
There is no one best choice; you need to just find the best choice for you. Try out the different interfaces and see which is most comfortable for you.
Raymond F. Posa, MBA, Farmingdale, NJ, rposa@themantagroup.com
08/19/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Legality of Maximalist Running Shoes (Robert Bijak, DPM)
From: Steven King, DPM
Podiatrists and pedorthists are called upon to develop technologies that reduce the incidence of injuries while improving athletic results.Our profession should take a closer look at Rule 143 of the U.S. Association of Track and Field. According to the USATF 2011 rules: "NOTE: Orthotic inserts required for medical purposes are exempt from this rule."
Steven King, DPM, CPed, Maui, HI, kingetics@gmail.com
06/20/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: EHR and Productivity (Juliet Burk, DPM)
From: Joe Agostinelli, DPM
Dr. Burk's letter should be used by the APMA to illustrate to the "powers that be" in Wash. DC! She eloquently demonstrates the EHR problem that one and two person practices will have with EHR.
I am fortunate to be part of a large orthopaedic practice with 50 staff members, a few dedicated to the reporting parameters needed to receive incentive monies. I echo everything Dr. Burk has stated for the single practictioners. Each of our physicians, except me, for some reason, has experienced decreases in outpatient visits and surgeries, and our patients have experienced delays because of...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
06/02/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Touch Screen Notebook (Laura R Lefkowitz, DPM)
From: Marc Garfield, DPM
There are several considerations before you buy a tablet.
1. Before buying a tablet, contact your vendor for recommended specs and operating system requirements: Ipad, XP (Yes some still only work with XP), Vista, Windows 7, 32 bit or 64 bit OS. MANY programs will not support 64 bit Windows operating systems, and you may need to replace the OS.
2. Weight, a 5 lb, 12 inch fully convertible tablet/notebook gets heavy after a couple of hours. Bigger screens and batteries will cause considerable wrist pain.
3. Power: The new windows slate tablets run off of the “atom” processors, designed for lighter use programs. This will hamper multi-tasking and...
Editor's note: Dr. Garfield's extended-length letter can be read here.
05/28/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: SC Medicaid Elimination of Podiatry Services (Robert Bijak, DPM)
From: Mike Piccarelli, DPM
I tend to disagree with Dr. Bijak. A fair share to a probable majority of patients are treated by podiatrists in Article 28 clinics, with most facilities associated with a residency program. The restriction only applies to private billing, and at least in my area, Medicaid patients are mostly treated in clinics by all specialties, not privately. Our situation is not due to redundancy; it's political.
Mike Piccarelli, DPM, Staten Island, NY, mcpdpm@verizon.net
05/23/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: To Be or Not to Be an MD/DO (Leonard A. Levy, DPM, MPH)
From: Paul Kruper, DPM
If I had to depend on income from ankle surgery, triples, flatfoot surgery, calcaneal fractures, and the like, I would have starved a long time ago. These procedures will never become a large part of my practice. A common complaint in podiatry circles is not enough patients or surgical cases. Solution: Upgrade to a plenary full scope DPM license. My practice would overflow, providing primary care to just diabetics, arthritics, and derm problems. Almost all podiatrists could provide primary care to these patients. It is time to expand the scope of the DPM license. The MD/DO is not necessary.
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com
05/19/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: CMS Attestation (Chris Browning, DPM)
From: Mark K. Johnson, DPM
I provided web-based CMS attestation for EHR meaningful use on April 16th. We are using certified software from one of the major podiatry vendors. The attestation process is fairly straightforward using data from your software generated reports. Some items are opted out for podiatry if you, for example, have not given immunizations; or, if you have a zero patient number in the denominator. You receive immediate feedback as to qualification online after completion of the process. The website allows you to track the progress of the "bonus" and currently ours has been sent on to the Payment File Contractor (PFC). It is expected to take 4-8 weeks from the time of successful web attestation until payment is made. I know nothing beyond that at this time.
Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net
04/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Paul Resignato, DPM
I have had success with Tricare/Triwest paying for the use of the bone stimulator on osteotomies.
Paul Resignato, DPM, El Paso, TX, pauleo@juno.com
04/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Exogen Bone Healing System (Russell Trahan, DPM)
From: Vince Marino, DPM
Dr. Trahan in his post on Exogen Bone Healing System states, “ It indeed has an FDA indication for fresh fractures.” Of course, the Exogen reps will also tell you the same thing - that Exogen is the only bone stimulating system indicated for the treatment of fresh fractures. According to some of them, the Exogen unit is the next best thing since sliced bread.
What they often fail to tell you is that there are only limited types of fresh fractures that the FDA gave the indication for. As taken directly from Exogen’s website...
Editor's note: Dr. Marino's extended-length letter can be read here.
04/25/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Randolph C. Fish, DPM
I have used the Exogen 4000 by Smith and Nephew successfully for non-union fractures in diabetics and dysvascular patients. I believe it is the best bone stimulator on the market. I have had one complication, however. A young female with a delayed healing calcaneal fracture started using the device, then developed severe pain in the calcaneous.
After the first few uses, she always developed severe pain, slowly decreasing over several days. I have asked Smith & Nephew several times, even speaking to a scientist on one occasion, about the etiology of the pain, but no one has been able to provide an answer. I found four reports on the Internet about bone pain using the device, but no answers. Has anyone else seen this problem?
Randolph C. Fish, DPM, Tacoma, WA, rcfish1@juno.com
04/22/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (Elliot Udell, DPM)
From: David Finkelstein, DPM
Although I don't take blood pressures on all my patients, I do take them on all nail and wart surgeries done in the office. But one day when a lady was bringing her mother in for nail care, she came up the reception desk and said her mother was still in the car and not feeling well so she was going to take her back home. I insisted that she bring her into the office and seat her in the reception area. Her blood pressure was extremely low and she was lethargic. I called 911 and she was transported to the hospital. She ended up getting a pacemaker, and had she gone home, she would have died. Another life saved by simply taking a blood pressure.
David Finkelstein, DPM, Oak Lawn, IL, dfinkelstein@pol.net
03/21/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Affordable Healthcare Act of 2010 /Obamacare (Marc "Merlin" Mauss)
From: Narmo L. Ortiz, Jr., DPM
I would like to ask Mr. Mauss, and your point is...? The definition of welfare is clear in many dictionaries: health, well-being, prosperity. The word has been in use since the Middle Ages, so you think it was used in a different context when the U.S. Constitution was drafted?
If a government has the power to excise taxation from its citizens to contribute to the general welfare and security of the country they reside in, it also should have the duty to provide such welfare in the way it sees fit, when appropriate, and in a legal manner for the benefit of the citizens of such country.
Now leave it to the hundreds of lawyers and amendments that have been passed in the last 200 plus years, and what has been created is a Pandora's box of irregularities and self-interest benefits.
Narmo L. Ortiz, Jr., DPM, Cape Coral, FL. nlortizdpm@embarqmail.com
03/19/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Affordable Healthcare Act of 2010 /Obamacare (Jerry Falke, DPM)
From: Robert Bijak, DPM, Richard A. Simmons, DPM
I read with incredulity the nonsensical reply of Dr. Falke. He missed the point entirely. I said there is no reference to the word HEALTH. I said nothing about the term "general welfare" not being in the constitution! Dr. Falke is in the bubble, not me. As long as we have podiatrists who can't discern a few simple sentences, our hope to become MDs or unlimited licensed DPMs is highly questionable.
Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com
Dr. Bijak's statements, as he wrote them, are correct. The contortions of Dr. Bijak's statements are false and misleading. Dr. Bijak correctly wrote that there is no mention of the word "health" in the United States Constitution. Dr. Bijak correctly asserted, "NOWHERE in the Constitution of the United States of America is HEALTH mentioned AT ALL!"
Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com
02/03/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3 (CLOSED)
RE: Employee Embezzlement (Name Withheld)
From: Jeffrey Kass, DPM, Name Withheld
Call the police. Your employee needs to be arrested. You state the employee was trusted. She broke the trust and now must face the consequences.
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com
I would like to thank Dr. Barry Block and all the PM News readers who provided excellent advice on how I should handle this situation. On Friday, I met with the district attorney, and today my receptionist was arrested. I have retained an attorney, and I will be suing the bank that opened the fraudulent account in my practice's name.
A preliminary accounting shows that I have been embezzled out of at least $50,000. I implore my colleagues to put in place adequate safeguards to prevent this from happening. I may never recover the money, but if my story can help others, then all will not have been in vain.
Name Withheld
