08/23/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Wart Treatments (Theresa M. Hughes, DPM)
From: Kevin A. Kirby, DPM
I have been using Falknor's needling method both for solitary and mosaic verrucae quite successfully now for the past 20 years. The late Gordon W. Falknor, DPM, first described this "needling method" for verrucae plantaris treatment in "Falknor GW: Needling-a new technique in verruca therapy: a case report." JAPA, 59:51-52, 1969.
Falknor originally described his needling method to offer the following advantages:
1. A minimum of time is required to perform this technique.
2. A minimum of material (anesthetic, syringe, dressing) is employed.
3. There is a minimum of post-operative pain.
4. A minimum of bandaging and dressing is needed.
5. A minimum of post-operative calls are required.
6. No ulceration, infection or scarring results.
7. The patient may continue to bathe as usual.
8. There are no restrictions on work or athletic activities.
9. There is a low rate of recurrence.
These have also been my clinical observations in the numerous times I have performed his technique on my own patients over the past two decades.
A more recent study of 45 patients was just published a few months ago in the Journal of Clinical Medicine that showed a 69% resolution of verrucae following needling treatment (Longhurst B, Bristow I: The treatment of verrucae pedis using Falknor's needling method: A review of 46 cases. J. Clin. Med. 2013, 2, 13-21: doi:10.3390/jcm2020013).
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
08/20/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Diagnostic Ultrasound (David E. Gurvis, DPM)
From: Bryan Markinson, DPM
Drs. Gurvis and Foreman take my research idea and interpret that my intention is to prove that ultrasound use is fraudulent or somehow unethical, or even unnecessary. Nothing could be further from the truth. However, I will never be convinced that the majority of current users are adequately trained in musculoskeletal ultrasound in proportion to its frequency of use.
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
07/18/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: SudoScan (Howard Dinowitz, DPM)
From: Robert Bijak, DPM
Of course, this is an INDIRECT inference; that should be obvious. The only direct test would be nerve conduction studies, and they should be performed by an MD neurologist. Forget the insurance reimbursement and do the right thing.
Robert Bijak, DPM, Clarence center, NY rbijak@aol.com
07/12/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Reliable Medical Billing Company
From: Steven Gershman, DPM
I have used MedBill Resources for about 15 years. They do all types of medical billing but are especially good with podiatry, including DME. They handle every aspect of the receivables and any insurance company denials. Outsourcing billing to them was my best decision. Contact Pat Roy at 207 786 8816.
Steven Gershman, DPM, Auburn, ME, obsidianom@aol.com
07/11/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Reliable Medical Billing Company
From: David Mullens, DPM
I have used Caroline Kats in San Francisco for all of our billing for 5+ years. She is nothing less than sensational. When I told my wife/office manager I wanted to hire Caroline for our four-doctor practice, my wife was really against hiring an outside biller. Within three months, my wife thought Caroline was the best thing ever to happen to the practice.
Caroline is smart, hard-working, knowledgeable, and experienced. We scanned and emailed all of our routing slips (superbills) and checks (with attached EOBs) every day. It was painless and completely effective. In addition, Caroline was expert at handling patients calling with payment issues. Her email address is carolinekats@yahoo.com. Call her. You won’t be sorry.
David Mullens, DPM, Palo Alto, CA, dmullens@mullenslawoffice.com
05/29/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Square.com (Andy Dale, DPM)
From: Philbert Kuo, DPM
If you are considering Square.com, then also take a look at Paypal.com. I think it's about 5% less expensive. Do a Google search on mobile credit card readers and read the reviews to get a better understanding of what is available.
Philbert Kuo, DPM, Chesapeake, VA, philbertkuo@gmail.com
05/27/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Gary Docks, DPM
Your ghost caller with symptoms of diabetes and an ingrown toenail was not given a same-day appointment after you specifically told your office manager and receptionist to do so, can only mean one thing. Who the hell is running this practice? The only acceptable response would be how long have you been working here NOT INCLUDING TOMORROW? You need to take control of this situation.
I faced that situation many years ago and nipped it in the bud quickly. The question is, did you put a limit on how many patients you wanted to see in a day or perhaps after watching you, THEY decided for you how many patients would be seen. Do you spend a lot of time with each patient? Take control of your practice or don't complain. After your ghost caller verified your suspicions, unless they had a good explanation for their actions, I would make sure that the door to your office hit them in the ass on their way out. Pull the plug and take some management classes to prevent this from happening again.
Gary Docks, DPM, Beverly Hills, MI, gwdocks@aol.com
05/06/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: The Podiatric Residency Crisis
From: Leslie Levine, DPM
I've heard the old adage that there is no such thing as bad press. However, after reading the first two posts in the May 1st edition of PM News, if I were an outsider looking in, I'd be hard-pressed to understand the need for a 3-year surgical residency to warn the public about the perils of nail salons and improperly fitting sneakers. I'm sure the flip-flop and high heel warnings will begin to appear soon.
Lo and behold, what appeared in the May 4th edition... a reprint of an article quoting none other than the distinguished president of the APMA warning of the dangers of flip-flops.
Leslie Levine, DPM, Orangeburg, NY, LILevine@aol.com
04/24/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)
From: Lynn Homisak, PRT
I too would like to say "BRAVO!" to Dr. Moskowitz for speaking up! I have also seen this kind of manipulation going on in way too many offices...ever since the rules came out from Medicare about specific nail care coding (way back when.) Sadly, there are still offices that continue to work the system by manipulating codes and documentation in order to get paid and/or retain patients. It makes it bad for those who make the effort to code properly.
The doctor I worked for in NJ called 'em like he saw 'em, and like Dr. Moskowitz did not submit claims for non-covered nail services. Patients were informed what was and wasn't covered, signed an ABN, and paid cash. Period. As a result, we may have lost some patients to DPMs down the street who we were told submitted (erroneous/fraudulent) claims for them, but we never had problems sleeping at night! It's always better to do the right thing.
Lynn Homisak, PRT, Federal Way, WA, lynn@soshms.com
04/15/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: gSource Instruments (Jack Ressler, DPM)
From: Ronald F. Iannacone, DPM
gSource instruments are great quality instruments at a very reasonable price. I started buying from them last year and have not had a problem with their instruments at all. Their staff is also very friendly and willing to accommodate you.
Ronald F. Iannacone, DPM, Northport, NY, rfiannaconedpm@yahoo.com
04/08/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Call Pay (Charles Myers, DPM)
From: David Secord, DPM
Some years back, I was solicited by the orthopedic group at the community hospital Level II trauma center to take everything below the knee which came into the E.R. I was generally for the idea until I found out that the standing call payment made to the orthopedic doctor when taking this call was not going to be shared with me when I took over. In essence, they wanted me to take the call, accept the liability, very likely do the operative case gratis (as a majority of the individuals coming to this facility had no insurance), eat the cost of the follow-up care, and THEY would keep the call fee. I obviously didn’t agree to such an absurd arrangement, but if there is a call fee, it is probably something the orthopedic group covering at your hospital arranged. If you can get them to share it, you made out better than I did.
David Secord, DPM, Corpus Christie, TX, ledocdave@hotmail.com
03/01/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Pre-Authorization for Imaging (Bill Weis, DPM)
From: Cynthia Ferrelli, DPM
Yes, I agree that pre-authorization for imaging can sometimes be tedious. I actually make the call myself because I don't feel that my staff understands the patient's case enough to answer all of the detailed questions that are asked. It only takes me about 10 to 12 minutes to do this, so it does not bother me that much. I am not sure how the imaging facility could answer questions about the patient's case since it is not their patient.
With the authorization companies that I deal with, they are asking questions like: Has the patient used a cane or crutches? Has the patient failed a course of physical therapy? Has the patient taken NSAIDs? Does the patient have a documented range of motion? If I really want the patient to have the imaging study performed, I feel I need to make sure all of the answers are accurate so that I am able to obtain authorization and help the patient's case.
Cynthia Ferrelli, DPM, Buffalo, NY, drfoot1@roadrunner.com
02/15/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Cryoprobe or Alternative (Michael Forman, DPM)
From: Dock Dockery, DPM
The CryoProbe cryotherapy unit is alive and well and is operated by H-O Equipments, Inc., out of Mount Pleasant, SC. Contact philip.adams@ho-equipments.com for more information. I am a big fan of the newer CryoProbe units for the treatment of benign skin conditions like warts and plantar keratotic lesions.
Disclosure: I am a Clinical Consultant for CryoProbe.
Dock Dockery, DPM, Seattle, WA, gdockdockery@aol.com
01/22/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Be Prepared for Healthcare Changes - Part 2
From: Joseph Borreggine, DPM
I do not want to leave people hanging with words of discouragement and wondering what to do from here on out. My last post left no possible solution for the time being, but rather was doing nothing more than "stir the pot" so to speak. I am not in any way disenchanted with the profession choice that I made. It is what it is, and I am going to fulfill my obligation to it until I retire or until I am no longer able to be productive in the profession.
Regarding the changes to healthcare with all the inordinate policy changes and regulation that I spoke of previously, I would like to offer some suggestions for practicing podiatrists. These suggestions may be...
Editor's Note: Dr. Borreggine's extended-length letter can be read here.
12/20/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Efficacy of "Pain" Creams (Allen Jacobs, DPM)
From: Tip Sullivan, DPM
I appreciate the input that I have seen on the topic of “pain creams” but have an interesting observation. It seems as though pain cream (which has a very low SE profile) is being advocated for use when po meds (with significant SE profiles) are not effective. In my mind, that does not seem rational. I think that the low risk meds (topical) should be at least attempted before the higher risk meds (po meds). I do not see primary care, neurologists, or endocrinologists using pain creams as their first line of attack.
I wonder if it is because of their experience with ineffectiveness, the cost, or their training. Is there anyone using this as the first line treatment of choice? Again, my experience is that the effectiveness of these creams is unreliable regarding who gets symptom relief and who does not. Should I allow the compounding pharmacist to make that decision?
Is there any compendium or data that one might use to help guide choices? As Dr. Jacobs pointed out, there seems to be data available regarding specific in vitro findings, but I seem to be having some problem finding valid studies that are not financially-influenced. As the Mayo Clinic site says, “Opinions differ on the effectiveness of over-the-counter topical pain medications. While many people say these products help relieve their arthritis pain, scientific research reveals only modest benefits. Some products work no better than placebo in relieving arthritis pain.”
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net
12/15/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Efficacy of "Pain" Creams (Tip Sullivan, DPM)
From: Larry Kosova, DPM
For the last several years, my sport medicine practice has been using TPS from Total Pain Solutions. My rep's name is David Jones and his phone number is 847-337-7008. I have used this personally for about 6 months on myself, my wife, and both active children to relieve us from various problems including pain, before using it on patients. I have been amazed with the relief that I have experienced.
I am able to keep athletes of all calibers active with greatly reduced pain. The compound pharmacist uses very strong active medications, but in a cream form which has to be applied 3-4 times a day in small amounts. Some of the ingredients include diclofenac, baclofen, gabapentin, etc.
What I like about this company, is that if something is not working, you and/or the patient can call the pharmacist, and after getting more information from the patient, he will remake a "custom" formula that should work better. The customer service of this company has been some of the best I have experienced in 25 years of practice.
Disclaimer: I have no affiliation with this company.
Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com
09/24/2012
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: A Bullied Teen Patient (Billie Bondar, DPM)
From: Elliot Udell, DPM
Perhaps some of our legal experts can enlighten us as to how we should handle a case of where a child tells us that he is being physically bullied by other students. Are the laws the same as they are in cases of parental abuse? Are we allowed or even obligated to report the matter to the school without the patient's permission? I could envision a scenario where the kid might not want to tick off his peers who are bullying him and might deny the matter or even sue the doctor for violating confidentiality laws by reporting the matter.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
Editor's comment: PM News does not provide legal advice. In a growing number of jurisdictions, there is duty to report suspected abuse of patients under 18 or over 60. The proper authority to contact about suspected cases of abuse is generally child protective services, rather than the school. One should contact a local office to ascertain whether it is appropriate to make an official report.
