07/18/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: SudoScan (Howard Dinowitz, DPM)
From: Stephen Barrett, DPM, MBA
Peripheral neuropathy (PN) has many etiologies, and can have great variance from patient to patient. As we all know, there are two components to PN—sensorimotor and autonomic. There are numerous ways to evaluate the sensorimotor status of patients with PN, including, but not limited to NCV/EMG, clinical evaluation, epidermal nerve fiber density biopsy, high resolution diagnostic ultrasound for entrapment, neurosensory testing with the PSSD (pressure-specified sensory device), vibrometry, and physical evaluation, to mention a few.
However, autonomic dysfunction of the peripheral nervous system has, up until this point, relied solely on observation of xerotic skin, and the failure to sweat. The SudoScan device appears to be the first simple-to-use, reliable, reproducible, and objective measurement of...
Editor's note: Dr. Barrett's extended-length letter appears here.
07/12/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Reliable Medical Billing Company
From: Bessaliea Griffin, DPM
I am using American Healthcare Billing Services in Dallas, TX. They do an excellent job. One of the great things about the company is that it is operated by a licensed podiatrist. I am a new solo practitioner; therefore their knowledge and experience have been extremely helpful with proper billing and coding.
Bessaliea Griffin, DPM, Smithfield, NC, besgriffin@hotmail.com
05/25/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
Re: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Robert Scott Steinberg, DPM, William Deutsch, DPM
Dear Name Withheld, You have seen your employees' true colors. Will you ever be able to trust them again?
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com
Unfortunately, your staff is sabotaging your practice to ensure their workload is light or not overly burdensome, and to ensure their workday ends on THEIR schedule. The tail is wagging the dog. This is symptomatic of a dysfunctional office. New patients should receive priority scheduling, especially if they're in distress. That shouldn't have to be included in a manual; that's common sense.
I don't know how long your staff has been working for you, but they're not 'on your side.' With the job market as it is today, replacing your contrarian front office worker should be easy. Do you really think that an office meeting will change anything?
William Deutsch, DPM, Valley Stream, NY, wd.10301@yahoo.com
05/03/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Harvey Danciger, DPM
I had an X-Cel x-ray unit for over 10 years, and went to a digital x-ray system about 2 years ago. It was retrofitted to the X-Cel base and integrates into my EHR. The quality is very good and the support is excellent. In the long run, it will save you money over processing films. The company was FOZ Networks. Anytime I had a question or needed to know how to do something, I received an immediate response.
Harvey Danciger, DPM, Palm Desert, CA, docofeet@hotmail.com
04/24/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)
From: Don R Blum, DPM, JD
With all the comments and observations regarding DPMs who do not follow the rules as to routine foot care and exclusions, especially when we identify this related to a parent and/or family member, how many DPMs have then contacted the appropriate license board or insurer and complained?
Don R Blum, DPM, JD, Dallas, TX, donald.blum@yahoo.com
04/15/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: gSource Instruments (Jack Ressler, DPM)
From: David S. Wander, DPM
Our practice now orders exclusively gSource instruments for the high quality, reliability, and customer service. We have used a variety of their instruments, including surgical and palliative instruments, and all items have held up well to significant use and sterilization.
gSource has our highest recommendation.
Disclosure: Our practice has no financial interest in gSource.
David S. Wander, DPM, Philadelphia, PA, dswdpm@gmail.com
04/08/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Call Pay (Charles Myers, DPM)
From: Neil A Burrell, DPM
Our group covers the ER of two hospitals 24/7. Three out of four of us participate. We are paid 116.00 a day for being on call. We bill the patient's insurance and attempt to collect from those who do not have insurance. Most of the calls we get are notifying us of an admission. The hospitals set the payment of 116.00 per day. They used a formula based on how often we got called in the past and how many self-pays they see. We are pleased with the arrangements.
Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com
03/01/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Pre-Authorization for Imaging (Bill Weis, DPM)
From: Gary J. Fischman, DPM, PhD
Pre-authorization is used by insurance companies to ensure medical necessity for the procedure. Since the referring physician knows the patient's condition, he/she should know the medical necessity for the test that is being ordered. That is why the referring physician has the obligation to apply for the pre-authorization.
Dealing with insurance companies and/or their agents is somewhat time-consuming. However, if you have all the information in front of you, it will go much easier.
Gary J. Fischman, DPM, PhD, Idant Laboratories, gfischman@idant.com
01/22/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Be Prepared for Healthcare Changes (Joseph Borreggine, DPM)
From: Robert Kornfeld, DPM
Dr. Borreggine echoes what I have been warning against for years. I wholeheartedly agree with his assessment of the future of our profession. I do predict that many will go bankrupt, many will quit practicing, and many will be further drawn into the trap of fraud and wind up in big trouble. Those who choose to practice ethically and legally will experience a marked decrease in income and a monumental rise in stress.
This could not have happened if the profession had healthy self-esteem. It is apparent to me that the collective consciousness was one of self-sabotage. This is precisely the reason I brought up this issue. Rather than try to figure out "how to survive", I think it is more important to address how you "self-sabotage", which ensures that you will continue to struggle. The lack of interest in the thread on the Self-Esteem of Podiatry 2013 speaks volumes.
I spoke at the SAM conference in Orlando last Thursday, and after having conversations with many of the attendees, I see a very sad and defeated profession. It is important to note that the problems you are facing will not be healed by "external fixation". You need to dig deep and start looking at why you have been willing to watch your livelihood wither and your self-esteem atrophy.
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
12/21/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Policy for Handguns in a Podiatric Office (Frank Lattarulo, DPM)
From: Carl Ganio, DPM, Alan Shier, DPM
Your policy regarding handguns in the office should reflect and respect Federal and State Laws. In concealed-carry states such as Florida, it is not illegal to carry a gun into your physicians' offices. I have had many officers with weapons on their hip, and many patients with concealed weapons in their purse or fanny pack. So what? I await responses from podiatrists in states where it is perfectly legal to carry un-concealed weapons.
Do not allow this tragedy change the importance and intent that our Constitutional Forefathers forged into the Second Amendment. You have no idea how many weapons have passed in your presence without your knowledge...and perhaps someone carrying will save your life one day. Do not blame the weapon.
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz
Why would you have a problem with a law enforcement officer carrying his service weapon in your office? They usually carry their weapon wherever they are while off duty. We want them to! Who else would be carrying a legal weapon in NYC?
Alan Shier, DPM, Little Falls, NJ, alan553@aol.com
12/20/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Efficacy of "Pain" Creams (Gerald I. Falke, DPM)
From: Neil M. Scheffler, DPM
Watch for the potential side-effects, especially the DMSO: buzzle.com/articles/soothanol-x2-side-effects.html
Neil M. Scheffler, DPM, Baltimore, MD, feetone@aol.com
12/04/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: CMS to Now Cover Obesity Counseling (Michael Rosenblatt, DPM)
From: Robert Creighton, DPM
The contributors to this thread have made substantive remarks in response to Dr. Rosenblatt’s “plea” (my term) for some direction regarding podiatric education in the area of obesity counseling and what this means in a podiatric medical context.
It is true that most physicians know they have minimal education on the subject of diet and exercise. There was a recent article regarding how poorly trained physicians are to address the obesity epidemic...
Editor's note: Dr. Creighton's extended-length letter can be read here.
11/17/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: HBOT Oversight (Eric Goldenberg, DPM)
From: Elliot Udell, DPM
One of the problems with hyperbaric oxygen therapy centers in my geographic area is that many, if not all, of them are affiliated with wound care centers. Both I and many of my colleagues have experienced loss of our patients to these centers when they were sent there solely for hyperbaric oxygen. The straw that broke the camel's back for me with regard to these centers was when a doctor working at one of these wound care centers lulled the patient into coming to him for the rest of his podiatric medical and surgical needs after his wounds were healed. I would love to use hyperbaric oxygen as an additional modality in the care of many of my patients with diabetic wounds and hope that these centers will someday find a way of of not taking over the total wound care of my patients.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
