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
09/14/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: CT Podiatrist Receives 3 Year Sentence and $134K Restitution
From: Ira Baum, DPM
These articles are sickening. Most responses focus on two issues: 1. Fraud and 2. Aggressive (or overly aggressive) post-payment audits. Fraud hurts every podiatrists and is fuels the fire for overly aggressive post-payment audits. No one can condone that. Overly aggressive post-payment audits negatively affect the doctor-patient relationship, increase physician psyche on practicing defensive medicine, and cause a reaction from third-party payers (not only the federal government). The response adversely affects the provision of healthcare, and potentially dangerous outcomes for patients. Regulations can be made that are impossible or impractical to follow. The enforcing, or not enforcing these types of regulations is a method of control and intimidation.
Drilling down the issue to services in nursing homes or geriatric patients, Medicare guidelines are antiquated, unjust, and need revision. It's simply unfair for those podiatrists who provide these needed service, and for the patients who need the care, but don't meet the regulatory requirements. Contact your legislative representatives and explain why these services are needed and why the regulations need to be more humane. Unfortunately, it is the only process that may lead to a resolution.
Ira Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net
09/13/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: CT Podiatrist Receives 3 Year Sentence and $134K Restitution
From: Michael M. Rosenblatt, DPM
Again, we have seen a recent publication of a podiatrist who will serve prison time due to a fraud conviction. His life and family are devastated. Healthcare auditors and prosecutors now regard podiatrists as one of their most accessible and easy sources for personal career advancement. All they have to do is generate computer printouts on repetitive Medicare claims for ingrown nail surgeries, especially in nursing homes. They concentrate on those who have the greatest numbers.
Then, they ask for your chart notes. Sometimes they just go right to the NHs and start interviewing patients. Incredibly, their....
Editor's Note: Dr. Rosenblatt's extended-length letter can be read here.
09/12/2013
RESPONSES / COMMENTS (NEWS STORIES) PART 2B (CLOSED)
RE: NY Podiatrist Roughed Up by Former Boyfriend
From: Jennifer Barlow, DPM
In response to Drs. Gordon and Sullivan's comments: I appreciate where you are coming from. However in this case, I don't believe the article reports any regrettable behavior on Dr. Splichal's part. I don't believe pictures had anything to do with what happened. I have to respectfully disagree with the "you are asking for publicity because of these pictures" rationale.
I believe PM News is a valuable resource. I learned of Dr. Splichal's work through PM News, as well as found my current job, and for these things, among others, I am greatly appreciative. I believe in freedom of the press. I just think that good judgment dictates that something of such a personal nature be kept private, unless permission is given. In my opinion, no pictures justified the publication of this information.
Jennifer Barlow, DPM, Berkeley, CA, jenbarlow36@yahoo.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
09/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2A (CLOSED)
RE: NY Podiatrist Roughed Up by Former Boyfriend (Jennifer Barlow, DPM)
From: Robert Scott Steinberg, DPM,
Prior to reading about Dr. Splichal in PM News, I had not heard of her. It's too bad she had trouble with her boyfriend. I hope they put him in jail. With that said, I believe you are missing something important. Dr. Splichal, has marketed herself, using the term, "Dr. Legs" along with other PR promotions. As far as the media seems to be concerned, "Dr. Legs" has diminished her professional persona in favor of more glam. It might not be fair how the media is treating her, if you only think of her as a DPM. She obviously thinks of herself as for more then just a DPM! She put herself out there for all to notice, and they did.
Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com
09/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: Remembering 9/11
From: Michael Lawrence, DPM
Once again, the 9/11 PM News contains a pointed reminder of the evil lurking in our world that so horribly expressed itself that fateful day. The words of the editor, as he attempted to process the events as was witnessed in real-time, are prolific and remain a reminder of the horrors of that day. They need never be forgotten, both for the human losses and some of our very innocence, as well as that the same evil continues to exist in our world today.
But as bad as those events surely were, in the same edition a wonderful story of good a loving concern for others, appears as well. The success of the Musella Foundation, begun by our colleague Al Musella, hitting ONE MILLION DOLLARS, given to help others, is staggering in a wonderful, heart-warming way. This is a true example of good which, thank God, also continues to exist today. And it is in every one of us, giving the opportunity to make real, positive differences. Thanks, Dr. Musella, for being such a wonderful example and an inspiration.
Michael Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com
09/11/2013
RESPONSES / COMMENTS (NEWS STORIES)- PART 1B
RE: NY Podiatrist Roughed Up by Former Boyfriend (Jennifer Barlow, DPM)
From: Tip Sullivan, DPM
I do not know the female New York podiatrist involved here and I wish her no disrespect. She may be innovative and new in her approach to how she is perceived by the public. Certainly all publications are not free of any bias, but they do have the duty to at least publish the truth. Unfortunately, sometimes the truth hurts.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
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
09/07/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2
RE: NY Podiatrist Sues Yelp Claiming the Website Posted Phony Reviews
From: Johanna Youner, DPM
Yelp removed the fake review after the media onslaught. I'm pretty sure that means I won.
Johanna Youner, DPM, NY, NY, jyouner@nyc.rr.com
09/07/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1
RE: IA Podiatrist Discusses Benefits of Earthing Footwear
From: Steven King, DPM, Steven D Epstein, DPM
Could we assume that helicopter ground crews and people who make computer chips are the healthiest because they wear electrical conductive footwear? Will standing in a wet shower barefooted once a day be long enough to "balance" my free radicals? I bet I have a lot of them.
When can we expect some peer-reviewed published research on grounding before it is accepted as true medicine? Once they sold irradiated water coolers at health spas claiming significant health benefits as well.
Steven King, DPM, Maui, HI, kingetics@gmail.com
This is a hoax, an Onion story, right? But it's not April Fool's Day yet.
Steven D Epstein, DPM, Lebanon, PA, sdepstein@yahoo.com
09/03/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: NY Podiatrist Sues Yelp Claiming the Website Posted Phony Reviews
From: Noah A. Blumofe, DPM
I had a similar situation here in Santa Monica, CA a couple of years ago. I had just asked some of my patients to post their experiences on YELP. Within a week, I had about 10 posts, giving me a 5/5 rating. Within a day of the rating, I got a call from the Advertising department, offering me the "upgrade" for $800 a month. I declined, stating that I couldn't afford it at the time (nor was I interested). The NEXT DAY, half of my posts were missing! They were "Hidden due to questionable sources" (they were all real from real patients). Luckily, I didn't have any negative posts at the time, or they would have highlighted them. YELP is a bully website.
Noah A. Blumofe, DPM, Los Angeles, CA, dr.blumofe@gmail.com
08/28/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: Human Feet Still Built for Life in Trees, Like Our Ape Relatives (James Judge, DPM)
From: Walter W. Strash, DPM
Before arrogantly dismissing "an old document written by sheep herders," I recommend learning about individuals like Lee Strobel, Francis Collins, and Stephen C. Meyer. Strobel and Collins are atheists turned Christians who believe that "old document". Dr. Collins is noted for his discoveries of disease genes and his leadership of the Human Genome Project (HGP).
Meyer is the author of a book called 'Darwin's Doubt' explaining the “Cambrian explosion,” where many animals suddenly appeared in the fossil record without apparent ancestors in earlier layers of rock. He tells the story of the mystery surrounding this explosion of animal life—a mystery because scientists have learned more about what it takes to genetically construct an animal. The Bible and none of this is 'old school thought' but truth.
Walter W. Strash, DPM, San Antonio, TX, podcanuck@aol.com
08/26/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: Human Feet Still Built for Life in Trees, Like Our Ape Relatives (Brian Lee, DPM)
From: James Judge, DPM
Bravo Dr. Lee. The term 'Ape-like' is confusing, especially when we are much closer to other tree-dwelling primates, but primates none-the-less. The facts and conclusions are indisputable at this point. Unless, of course, you hold that a 1,800-2,000-year old document written by sheep herders is a comparable scientific study. As for the scientific community catching up with the Bible, I can't wait for the discoveries that bats are in fact birds, and that world is but a flat disc. The irony of 'old school thought' is certainly lost on Dr. Lee.
James Judge, DPM, Wake Forest, NC, drjudge@wakefootandankle.com
08/24/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: Human Feet Still Built for Life in Trees, Like Our Ape Relatives
From: Brian Lee, DPM
Ape relatives? Really? I didn't realize that old school of thought was still getting traction. All the supposed "missing links" and bones discovered over the years have all turned out to be either actual primates (not transitional forms) or outright falsifications. Someday maybe, the scientific community will catch up to the Bible which says, each were created according to "its kind".
Brian Lee, DPM, Mt. Vernon, IL, sifootcare@charter.net
08/14/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: CA Podiatrist Discusses Heel Pain and Achilles Tendonitis
From: Steve Pribut, DPM
I am aware of the news section highlighting what is said by and of podiatrists in the news media. And I realize how difficult it can be to educate the journalist interviewing you on topics of which they know little.
I wanted to point out once again information about a battle I believed we had won years ago. It is the battle of words and thoughts that chronic tendon issues are not "tendinitis" but considered tendinopathy. PM News has covered this well and there is a recent CME that reviews this and other running issues in two parts. This and other articles over...
Editor's note: Dr. Pribut's extended-length letter can be read here.
08/10/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: NY Podiatrist Discusses Melanomas on Feet
From: Bryan C. Markinson, DPM
The statement "Skin cancer found on the foot is 50% fatal," in this news story is outrageous. Not only is it not true, but the term "skin cancer" is meaningless. Even if referring only to melanoma, the statement is false. But we do not know what the term is referring to. There are other skin cancers that can occur on feet that are not so ominous or even fatal. Some that are fatal can take 30 years to kill you.
I understand that in these interviews, the eventual written article takes twists and turns, but there should be some editorial review to prevent podiatric medicine from appearing ill-informed and putting forth frightening untruths. If this article appears in Dr. Hogan's hometown newspaper, he ought to right this immediately.
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
08/09/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: AAPPM Presents Practice Management Seminar for Third-Year Students
From: Tip Sullivan, DPM
I was very happy to see the post regarding the attendance of 3rd year students at practice management seminars. Most of them (except the ones sacrificed to the residency crisis) will have FOUR MORE YEARS before they can put the things they heard into practice. I don’t ever remember experiencing a practice management seminar when I was a student, resident, or fellow. With all the negative comments regarding the residency crisis and the plight of the student, at least this is one thing we are doing positively!
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
08/08/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: APMAPAC Donates $10,000 to CA Podiatrist's Campaign (Russell J. Barone, DPM)
From Joseph Weisenfeld, DPM
The Affordable Care Act is law. It specifically allows people to keep their current health insurance. Therefore, all the groups Dr. Barone mentioned are in compliance. If Dr. Rogers states that he supports the Affordable Care Act law, I hope he can count on your financial support.
You may believe that the benefits federal employees have are too generous. You can (and should) inform Dr. Rogers and your local representatives of your views, and ways to improve/amend this law.
Disclosure: My last political donation was to my local congressman for his support of podiatry. I oppose most of his political positions and he is aware of this.
Joseph Weisenfeld, DPM, Staten Island, NY, JATOE2@AOL.COM
08/07/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: APMAPAC Donates $10,000 to CA Podiatrist's Campaign (Russell J. Barone, DPM)
From: Lee Rogers, DPM
Obamacare is not an insurance plan. It is a new set of rules that insurance companies have to abide by. I have and will continue to propose that all federal elected officials be given a choice of Medicare or Tricare for their health insurance. If it's good enough for our seniors and our troops, it's good enough for Members of Congress.
Lee Rogers, DPM, Simi Valley, CA, lee@leerogersforcongress.com
08/06/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: APMAPAC Donates $10,000 to CA Podiatrist's Campaign
From: Russell J. Barone, DPM
Since we, as podiatrists, are being urged to support Dr. Lee Rogers for United States Congress (no matter what our politics), I would like to ask two questions of him: 1) Does Dr. Rogers support Obamacare for all Americans? If he were to win the seat in Congress and he says that he supports Obamacare for all Americans, then 2) Would he continually introduce legislation that would require all government workers (including The President, The Senate, U.S. Members of Congress, The Supreme Court Justices, etc.) to accept Obamacare as their form of health insurance with no exemptions? If he supports my requirements, then I will support Dr. Rogers!
Russell J. Barone, DPM, Hendersonville, NC, lpjrbar@aol.com
07/31/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: NY Podiatrist Angry at Medicare for Improper Refund Demand
From: Joseph G Smith, DPM
I am glad that PM News brought this poor man’s situation to light. I have never understood the double standard whereby we are limited to 12 months (formerly 18 months) to file a claim, but demands for reimbursement for supposed overpayment from the insurance companies seem to have no time limit.
Joseph G Smith, DPM, VA Beach, VA, jsmith531@cox.net
07/30/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: NY Podiatrist Angry at Medicare for Improper Refund Demand
From: Martin V. Sloan, DPM
I empathize with Dr. Chen and am glad his situation was rectified with FOX News' help. Medicare's improper refund demands may be more widespread than people realize, and their action warrants an investigation. I, too, received improper refund demands from CMS over the past few months for the diabetic shoe and insole service. Specifically, they demanded refunds of monies paid 3-4 years ago. They hired an independent agency to audit billings for A5500 and A5513 and this agency submitted the groundless refund demands. I responded appropriately with requests for "redetermination" and for "reconsideration", submitting all the necessary documents and detailed medical records.
All appeals on all patients at both levels (reconsideration and redetermination) were denied with no explanation other than to say an "independent doctor" has ruled the devices were not medically necessary. As we all know, the diabetic shoe program is very low profit. The only winners are the companies selling the shoes and custom-molded inlays. It's understandable that nearly 30% of the respondents to your recent poll have discontinued their involvement in this vital program. Indeed, this may well be what CMS desires.
Martin V. Sloan, DPM, Rockwall, TX, mvs32154@gmail.com
07/29/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: Missed Follow-ups a Potent Trigger of Lawsuits
From: Ellen Wenzel, DPM
We recognized early on the potential liability in missed appointments and even cancelled appointments in patients that require follow-up. It seems some of the highest risk patients are the worst recurrent offenders for missing appointments. Our office policy is 4 contact attempts with documentation. For all no-shows, the office staff calls the business day immediately following the missed appointment, then another two days later, and one week after that. If they are unable to reach the patient after the third attempt, a letter is mailed. Each attempt is documented with the outcome.
In addition, we document every cancelation with a reason and whether or not the patient re-appointed. When a patient does not immediately re-appoint and if he/she is one who requires follow-up (i.e., wounds and post-op), the same process is followed. We find many first time no-shows simply just get busy and forget (even with appointment reminders), and they appreciate the attention to their care.
Ellen Wenzel, DPM, Vancouver, WA, wenzeldpm@gmail.com
07/27/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: Missed Follow-ups a Potent Trigger of Lawsuits
From: Elliot Udell, DPM
The study discussed in the July 23, 2013 issue of PM News said the following: "... the most frequent risk-management issues were failure to contact patients after missed appointments and a lack of tracking to ensure appropriate follow-up care was completed."
After reading this, most of us probably nodded our heads in agreement and went on to the next topic. The topic, however, begs for more discussion. On one hand, the study quoted implies that if a patient misses a follow-up visit and something goes wrong, the patient may decide to sue the doctor. On the other hand, patients are adults, and to the best of my knowledge, there is no law anywhere which can force a person to keep any doctor appointment. So, let's open the floor for discussion. What have you done in your practices that has increased patient adherence in keeping appointments, especially post-operative visits?
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
