09/14/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: CT Podiatrist Receives 3 Year Sentence and $134K Restitution (Michael Rosenblatt, DPM)
From: Paul Kesselman, DPM, Richard A. Simmons, DPM
Aside from DME audits, reviewing claims for total or partial nail avulsions really is a slam dunk for carriers. Dr. Rosenblatt is very much on target when he suggests that DPMs benefit insurance carrier auditors by not documenting proper procedure(s) when it comes to nail removals (CPT 11730).
The following documentation should be placed in the patient's chart:
1) A consent form - If the patient cannot sign this for whatever reason, that information should be placed in the chart;
2) Notation of the name and dose of injectable anesthetic (unless you document neuropathy);
3) Removal of a substantial portion of the nail (total border from distal to proximal, or the entire nail)
4) Written post-op instructions should be provided and signed by the patient (give your office patients a copy) or write these orders in the NH or hospital chart.
5) The use of digital photography, while not mandatory by most MCR LCDs and private insurance carriers, is highly recommended.
For some MCR carriers it is mandatory for lessor toenails 2-5.
Paul Kesselman, DPM, Woodside, NY , drkesselmandpm1@hotmail.com
In the excellent letter written by Dr. Rosenblatt concerning the billing for CPT 11730 part of the procedure that he stated was necessary for correct billing required that the surgeon to “Remove a section of nail that includes eponychium.”
In Florida, our LCD 29318 does not require removing any of the eponychium, but it does require “the entire length of the nail border to and under the eponychium." This is not a procedure that I perform with any great frequency (probably less than once every sixty days); however, I have never done this procedure where it involved such extensive removal of the matrix region as would be required with excision of the eponychium. Is the excision of the eponychium a new requirement by CMS?
Richard A. Simmons, DPM, Rockledge, FL RASDPM32955@gmail.com
09/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: Remembering 9/11
From: Bruce G Blank, DPM
Thank you for continuing the tradition of re-publishing your editor's note of 9-12-01 in PM News. It was a day which touched all of us & one we will never and should never forget.
I remember one of the fire fighters from my elementary school days in Staten Island. I'm sure that there had to be others I knew when growing up or relatives of people I knew. However, all Americans were effected, whether they had a personal connection or not. I think this was an event which should continue to pull us all together as the attack on Pearl Harbor brought the Greatest Generation together.
Bruce G Blank, DPM, Martins Ferry, OH, bruceblankdpm@gmail.com
09/11/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: NY Podiatrist Roughed Up by Former Boyfriend (Jennifer Barlow, DPM)
From: Sloan Gordon, DPM
I really didn't want to enter the fray about what gets reported on PM News, however, I know that Dr. Block is very careful to report factual news that often displays regrettable behavior by some of our colleagues. I believe the point of the 'mention' was to simply state the news and the facts. I had never heard of Dr. Splichal and when I Goggled her, I was a bit shocked. After all, her Google page looks like a PR piece for a model.
I personally am a staunch defender of women's rights and abhor domestic violence, but you can't have it both ways. You can't have your picture all over the place in salacious poses and costumes and not expect that your every movement will be scrutinized, even by the paparazzi. I think PM News was simply stating the facts.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
07/26/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: Missed Follow-ups a Potent Trigger of Lawsuits
From: Michael Forman, DPM
Yes, failure to document follow-up on broken appointments is one factor that can work against the physician involved in a malpractice suit.
The written policy in our office is to place a call when a patient is 15 minutes late. If you reach them, allow them to blame you for their missed appointment. Don't be accusatory. We say, "Mrs/Mr. Patient, did WE make a mistake on your appointment? We had your name down at 3:15 PM today." We have never had a patient say it was our fault. Then you must memorialize this conversation in the patient's record! Even if they show up in 20 minutes, the fact that they are reminded at home that they were late for an appointment is beneficial.
Document late appointments as well as broken appointments. I have been asked how many times must you call a patient who broke an appointment. I don't think there is any specific answer. I recall a case where the plaintiff's attorney brought up the fact that the office only called once. What the heck, they could bring this up even if you called 15 times. Again, there is no good answer. My advice is to remind your staff to call and DOCUMENT that the office attempted to reach the patient.
Michael Forman, DPM, Cleveland, OH, im4man@aol.com
07/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: FL DPM Selected to Review Fulbright Applications
From: Ivar E. Roth, DPM, MPH
Kudos to Dr. Levy for leading the podiatry charge. Congrats, Dr. Levy; keep up the great work.
Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
07/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: Good Hygiene Prevents Fungal Infections/Odor: Singapore Podiatrist
From: Mike Boxer, DPM
Comment was made that foot odor comes from bacterial action on sweat. Any patient who has foot odor will tell you that they can wash their feet, dry them well, and within five minutes after putting on their footwear, their feet have a terrible odor. All patients with foot odor have hyperidrosis. The odor comes from bacterial action on the wet leather, and not bacterial action on sweat. Once the shoe is worn, the foot picks up the odor from the leather.
The only way for a patient to cure bromidrosis is to replace all footwear that has an odor. Often, the use of Bromi-Talc Plus (Gordon Labs bromidrosis powder) that contains Abscents Deodorizing Powder can rid the footwear of the odor. To prevent bromidrosis, hyperidrosis must be well-controlled to keep shoe leather from getting wet with sweat.
Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com
06/20/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: Scholl Professor Sues Associate Dean for Defamation (Lloyd S. Smith, DPM)
From: Jon Purdy, DPM
I have nothing but respect for Dr. Smith and his vast contributions to podiatry. The last thing I want to be known for is drive-by blaming. I don’t believe I blamed anyone or any entity, but simply stated the schools could do more to prepare students for the real world of medicine.
Years ago, I interacted with the CPME to help form new residency positions and did go through the system, so I’m certainly not an “outsider.” Maybe Dr. Smith is not aware that...
Editor's note: Dr. Purdy's extended-length letter can be read here.
06/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: Scholl Professor Sues Associate Dean for Defamation
From: Stanley W. Blondek, DPM, MD
As a Clinical Professor in Pediatrics at the Commonwealth Medical College in Scranton, Pennsylvania and a private practitioner, I would like to state that most, if not all, medical schools employ part-time faculty. You want those on the outside sharing their knowledge and practice experience with students. This does not seem to be the case with Scholl college.
I have been a visiting lecturer at Scholl College for the past 17 years in pediatrics and neonatology under Dr. Hrywnak in his medicine course. This situation about removing part-time faculty is to suppress academic freedom of speech. Dr. Hrywnak has always come to the aid of students and to promote podiatry. His salary is always donated back and his connections to medical rotations in Chicago have proven beneficial to podiatric medical students. His practice management course is unsurpassed by any other, preparing students for the reality of practice. I will miss coming to Chicago and teaching the Scholl students.
This lawsuit is long overdue. Since when does a PhD in embryology run a podiatric medical school? Are there no DPMs qualified? I write this post in hope that both sides can work out their differences and that Dr. Hrywnak can return to do what he does best, promoting podiatry and preparing the students for private practice. The changes in healthcare are upon us. Podiatry needs those willing to help and lead and not be suppressed by politics and selfish financial motives. It's not ethically and morally right not to keep students informed.
Stanley W. Blondek, DPM, MD, Scranton, PA, lackpeds@aol.com
06/15/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: Scholl Professor Sues Associate Dean for Defamation
From: Tip Sullivan, DPM
After reading the lawsuit, it saddens me to see this type of behavior from our educators-regardless of who is right or wrong. Perhaps, since one of the reasons that has been submitted for the cause of our residency problem is too many colleges, we should consider firing all of those involved and/or shutting down a school where this type of behavior exists. It sounds like a true restructuring needs to be done. I mean the whole kit and caboodle.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
06/14/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: Pronation from Flip-Flops Can Damage Feet: MI Podiatrist
From: Dennis Shavelson, DPM
It’s time to once and for all “bust the myth” that all pedal and postural mechanical problems result from primary pronation on the frontal plane of the rearfoot. In fact, although there are those who suffer from this malady, far more feet suffer from primary forefoot supination. Forefoot pronation is a viable treatment for most feet biomechanically. Dr. Bremer, stating that “Pronation is a condition that can lead to foot arch collapse, premature arthritis, bunions, and heel spurs" says so from a position that Dr. Dananberg, myself, and others have dispelled for decades, and is more and more accepted by the international biomechanics community.
I am tired of hearing from DPMs that biomechanics is too hard to understand, that it is pseudoscience, and that when a weight-bearing foot is “flat”, without examination or measurement, the culprit is pronation. Spreading this kind of false information on websites, in the media, and on the Internet without modern biomechanical knowledge and skill stands in the way of those of us who wish to practice podiatric biomechanics backed with science, skill, and the existing EBM.
We should be selling 1st ray cutouts, not RF varus posts, and we should be blowing away the wanna-be “pronator” biomechanists from our podiums, schools, residencies, and the social media. Every tri-plane joint pronates to good and bad ends. To hear my profession continue to try to convince the foot and postural suffering public that “pronation is bad” is a myth that needs busting.
Dennis Shavelson, DPM, NY, NY. drsha@foothelpers.com
06/13/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Hartley Miltchin, DPM)
From: Tip Sullivan, DPM
If Dr. Miltchin is truthful in his post, stating that he has NEVER had a recurrence of a bunion, NEVER had a non-union, NEVER had a hallux varus, and NEVER had a transfer lesion in 31 years of practice doing “a significant number” of MIS weekly, I believe that he should be teaching someone else his secrets. That would be roughly 4,500 cases with NONE of the above complications. Almost unbelievable and certainly deserving of some sort of an award.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
06/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: Bigger Heels Equal Bigger Tips for Casino Waitresses: CT Podiatrist
From: Ira Weiner, DPM
Being from Las Vegas, the cocktail waitress capital of the world, this has been something we deal with on a regular basis. Nearly all of the casinos have adopted a "reasonable and comfortable" shoe policy. Caesars Palace was one of the first casinos to allow a more casual sandal, as many of their waitresses were "older" and unable to wear the high heels.
Several years ago, one of the things we as podiatrists were doing was to write shoe modification letters for our waitress patients so they would be allowed to wear a lower heel or an open toe. Over the years, the casinos saw the problems the high heels were causing for their waitresses and nearly every casino began to allow a more sensible shoe to be worn. Most of the waitresses have gone to a low dance heel and many of the problems have been eliminated.
One of the last holdout casinos, the Imperial Palace, finally relented as well just before they closed down for remodeling and "rebranding."
Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com
06/11/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Randall Brower, DPM)
From: Alireza Khosroabadi, DPM
Let me start by saying that the tone in Dr. Brower's comment on PM News was full of criticism, negativity, and bitterness. I am very shocked to hear such a closed-minded comment. Dr. Brower, you need to keep up with your readings of medical journals. The percutaneous bunionectomy that I perform was published in JBJS a few years ago. It was a five-year follow up of 118 feet with 91% satisfaction rate.
 |
X-rays (initial post-op and at 12 weeks) submitted by Dr. Khosroabadi |
I am a very well respected surgeon in my community and collaborate with other....
Editor's note: Dr. Khosroabadi's extended-length letter can be read here.
05/28/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: New Study Confirms Hereditary Link for Bunions (Elliot Udell, DPM)
From: Leonard A. Levy, DPM, MPH
Elliot Udell, DPM is right that there are more than hereditary factors that lead to bunions and many other pedal deformities. However, these factors are products of the human genome. Genomics unlike genetics which refers to diseases that are due to a single gene (e.g., sickle cell anemia, hemophilia, etc.), is the study of all genes in the human genome interacting with each other as well as the environment.
If they have not done so already, podiatric medical schools, residencies, and continuing education programs need to include genomics as a core part of the continuum of podiatric medical education. The current director of NIH who previously directed the National Human Genome Research Institute referred to genomics as “one of the major landmarks that rank up there with going to the moon.”
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu
05/07/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: Laker Basketball Star's Injury May Have Been Preventable: TX Podiatrist (Ed Davis, DPM)
From: Amol Saxena, DPM
There is no level 3 or higher study to support that Achilles tendon ruptures are associated with having ankle equinus. Quoting one level 4 study is not very assuring. Furthermore, there is also no evidence that stretching and other rehabilitation techniques are helpful. In fact, the mainstay of treatment for Achilles tendinopathy (but not ruptures) is eccentric strengthening. All NBA teams have a rigorous conditioning and rehabilitation team that utilize these techniques. Unfortunately, ruptures are just part of the sport. If stretching the Achilles is so helpful, why do virtually all patients who present with Achilles tendinopathy state they already have been stretching when they come in for treatment?
In addition, trying to reduce the equinus in an athlete can be...
Editor's note: Dr. Saxena's extended-length letter can be read here.
04/30/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: Appreciative Jerry Seinfeld Donates to NYCPM
From: Richard Jaffe, DPM, Keith Gurnick, DPM
I want an apology from Jerry Seinfeld because in one of his shows he said, "anyone can get into podiatry school." It was defamatory and did not foster a positive impression of our profession.
Richard Jaffe, DPM, Jerusalem, Israel, footsurg@netvision.net.il
Without violating any HIPAA rules, but because of my involvement in the orthotic industry, I know that there were multiple podiatrists (not myself) who treated Mr. Seinfeld's condition during the time his TV show was made in Los Angeles. Each claimed to successfully treat his conditions at the time, and each was honest. From what I was told, Mr. Seinfeld loved his podiatrists and they loved him. One podiatrist can be seen sitting at a table in the diner in an episode of his TV show.
It is very nice and gratifying that Mr. Seinfeld has made a meaningful contribution to the NYCPM, however...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
04/26/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: AMA Initiative to Target Diabetes, Heart Disease (Robert Creighton, DPM)
From: Lawrence M. Rubin, DPM,
I agree with Dr. Creighton's suggestion that the APMA be involved in multidisciplinary efforts to help control the epidemic of diabetes and pre-diabetes. But we don't have to wait for the APMA. Every podiatrist can act almost immediately to effectively help fight the "War Against Diabetes" in his or her own community. There are clubs and organizations everywhere that are looking for speakers at their meetings. So, call your local Chamber of Commerce which can probably send you a list of organizations and other groups (such as companies that have corporate wellness programs) looking for speakers.
Make contact with these groups and offer to give a talk about the importance of having a personal exercise program which, along with other benefits, will help prevent type 2 diabetes. In your talk, you can explain the importance of taking care of painful foot problems in order to be able to walk and exercise comfortably. Develop an interesting and informative talk, and before you know it, groups and organizations will be calling you and inviting you to speak. And, by the way, in the course of doing good for your community, you will have fantastic publicity and will start seeing new patients wanting you to help them get rid of their painful foot problems so they can become more active. Win/Win for everyone. Give it a try.
Lawrence M. Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com
04/25/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: AMA Initiative to Target Diabetes, Heart Disease
From: Robert Creighton, DPM
I was pleased to see the post today on the AMA’s effort to confront the various aspects of the pre-diabetes epidemic. This should be a multidisciplinary effort, and the APMA should be formally involved in this mission to stop pre-diabetes. As we know, the impact on metabolic health from the large muscle groups of the lower limbs is tremendous. We need to better academically and intellectually make the connection between lower extremity biomechanics (physics) and metabolism (physiology) so that we as a profession may practically impact the health of our country in this area.
If we had more formal education on the role of movement, food, and lifestyle on health, we would be able to make a much more meaningful contribution - one beyond simply educating our patients on proper shoe fit and the hazards of hyperpronation. I was happy to see that there is an “Exercise is Medicine” lecture at my state’s upcoming podiatric medical association meeting. We need more of that.
Robert Creighton, DPM, St. Petersburg, FL, rcreightonjr@hotmail.com
04/22/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: 104 Applicants Not Matched for Residency Positions
From: Amram Dahukey, DPM
So now, the blame game is on, and everyone is trying to blame someone for the shortage of residencies or offer different short-term solutions. One doctor even suggested it is time to sunset the DPM and offer an MD degree. Almost 20 years ago, as delegate of the Arizona Podiatric Medical Association, I circulated a notion that the solution to our specialty integration into the mainstream medicine, is by changing the curriculum of the medical schools so that students will have a dual degree MD or DO and a DPM. It was a time when the debate was raging about whether we should include the ankle or just foot as scope of practice.
The solution I offer is two-fold: change of the education system to grant both degrees even if it requires an additional year in school, and accept students based on the projected number of residencies at the time of enrollment. I believe that these changes must be made now for podiatric medicine to become an accepted specialty of medicine. Many of the hurdles we as practitioners encounter on a daily basis will be removed. This is not an issue of pride, but of practicality in daily practice in hospitals, and even in insurance acceptance issues.
Amram Dahukey, DPM, Tucson, AZ, drd@premiersurgeons.com
04/20/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: TRAKnet Announces New and Improved Support Line
From: Hal Ornstein, DPM
While TRAKnet had shortcomings in the past, its future looks very bright! TRAKnet and Revenue Cycle Management (RCM) were recently acquired by Nemo Capital Partners, LLC, a group of podiatrists who has had their fingers on the pulse of the needs of their colleagues for a long time. Each has vast experience in the world of EHRs.
I personally know each of these podiatrists very well and can state with conviction that they have the wisdom, passion, hearts, and fortitude to do their very best with TRAKnet and RCM. I know that in the coming months this software will become all that it can be, and that it will address the needs of the users on all levels. While it will take a bit of patience on our parts, I am confident that the Nemo team will not disappoint. They have concrete plans for the software’s enhancement and have assembled a great team of experts. They vow to listen to and communicate with their fellow colleagues.
I want to be clear that I am not in any way an investor in Nemo or TRAKnet, nor will I have any financial gain at all from this transition.
Hal Ornstein, DPM, Howell, NJ, halo@footdoctorsnj.com
04/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Joe Agostinelli, DPM
Let's think out of the box on this. Is it time to consider a radical change in our podiatry world? Should we have a goal of letting the DPM degree sunset, having our students attend regular MD or DO medical school for four years, complete a one-year internship, where you learn to be a physician first, then complete a two-year residency in podiatric medicine/surgery with follow on specialty fellowships to develop a "regional foot and ankle specialist" MD or DO physician?
Please do not comment that we are already "physicians" according to some federal definition that has no practical...
Editor's note: Dr. Agostinelli's extended-length letter can be read here.
04/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: 104 Applicants Not Matched for Residency Positions
From: Leonard A. Levy, DPM, MPH
Jumping to Conclusions about the Current Residency Crisis: An Evidence-Based Approach
The number of podiatric medical students failing to match in the current residency cycle has nothing to do with number of schools. First year student enrollment in 1985 was far fewer than the number enrolled today, even though there are now more podiatric medical schools. Furthermore, the U.S. population in now more than 308 million compared to 281 million in 2000. Also, today more than 40 million people are age 65 and over compared to 35 million in 2000.
By the year 2020, when newly enrolled podiatric medical students will be completing their training, the need for podiatric physicians will be...
Editor's note: Dr. Levy's extended-length letter can be read here.
04/17/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: TX Podiatrist Discusses Many Benefits of Epsom Salt Foot Soaks
From: Joshua Kaye, DPM
In reading the plethora of scientific information over the years regarding the uses of Epsom salt, I was surprised to read Dr. Bowman’s comments regarding this salt. Any salt, including magnesium sulfate, is anhydrous, causes drying of the skin, and absorbs fluid from wounds and ulcers. However, I have never found any science that demonstrates that warm Epsom salt soaks have any benefit over warm table salt soaks of equal molecular concentration. I would appreciate being enlightened with non-anecdotal facts.
Joshua Kaye, DPM, Los Angeles, CA, jk@joshuakaye.com
04/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Robert Kornfeld, DPM)
From: Robert Kornfeld, DPM
I would like to clarify my offer since many of the 104 wanted to know how to "apply" to the Pre-Residency Fellowship in Integrative Podiatric Medicine. This offering is open to all of "The 104." There is no application necessary, only the desire to become part of medicine’s fastest growing sub-specialty of integrative medicine and the desire to become part of the residency shortage solution on a team, in community with collaboration.
We are looking to create a population of podiatrists who will enter their professional practices with an expanded focus on foot and ankle medicine. The fellowship will include medical training, education, and research through the lens of integrative medicine. These DPMs can become a resource and consultant for traditionally trained DPMs who wish to add a new dimension to their practice. Stipend: with the support of the profession, we are anticipating that each Fellow will receive a stipend of $27,000 - $38,000.
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
04/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1A
RE: 104 Applicants Not Matched for Residency Positions (Robert Kornfeld, DPM)
From: Dennis Shavelson, DPM
Dr. Kornfeld understands the 104 crisis, but I suggest it to be the iceberg tip of the DPM titanic crisis that podiatry is currently sailing on. Podiatrists, residents, and the “lost 104” need short, cheap, intense workshops and training programs to, as Robert has so aptly stated, establish “thoughtful, patient-specific diagnostic and treatment paradigms” in practice. These courses must also create a profitable core to practice that will ensure a respectable income commensurate with the investments we are making every day to be healers.
With that in mind, I am offering 1-2 or 3 day workshop/practice shadowing at The Foot Typing Centers of LifeStyle Podiatry in NYC to any lost 104 or current 2nd or 3rd year residents. These workshops will focus on Foot Centering Biomechanics®, Closed Chain Dermatology®, and “uninsured/uncovered” programs like lasers and in-offfice dispensing. There will be no associated fees.
I will allow 2 participants a week, starting in two weeks and lasting throughout the summer. Participants must dress, act, and behave professionally.
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com
