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RE: Inexpensive Cast Cutter (Joseph S Borreggine, DPM)

From: Judd Davis, DPM

I would like to thank Dr. Joseph Borreggine for his posting about the alternative to cast saws available. I bought a Sears Craftsman 2 amp oscillating multi-tool for $80, which works just as well as my defunct $1,000+ medical grade cast saw. The metal/wood/fiberglass blade that comes with the tool works like a charm, and safety appears identical, as it does not cut skin. It's disturbing to me that once a piece of equipment is labeled "medical", the price can be marked up ten-fold or more.


Judd Davis, DPM, Colorado Springs, CO,

Other messages in this thread:



RE: The Bell Tolls For Us (Mark S. Davids, DPM)

From: John F. Swaim, DPM

As I see the business future of podiatry, we will be forced to migrate into business structures such as hospital-based groups, multispecialty groups, or we will form regionally-based collectives for the purpose of bargaining for our services pricing. As we stand alone in solo practice now, there's no leverage to be had.

In Northern California, I've become a stranger to the monthly billing roll at ProLab due to ever-increasing deductibles. Blue Cross has cut custom orthotic reimbursement to $240, that's when they choose to cover them. I stopped accepting Retail Clerks/PPOC some years ago for the same reason. Blue Cross now denies an office visit when casting for orthotics as well. Most of the private insurance here is Blue Cross, and they pay poorly for everything podiatric, well below Medicare rates, and it isn't going up.

I've been advised in these sage pages to stop taking private insurance all together, and that day fast approaches. To be honest, it will be a relief. Hey, as an aside, did you see the article in The Wall Street Journal this week describing medical supplier McKesson's CEO's potential severance package? Had he chosen to leave the company back in March, he would have received $160 million - and we wonder where the money all goes.

John F. Swaim, DPM, Red Bluff, CA,



RE: The Bell Tolls for Us

From:  Mark S. Davids, DPM

Today, I received a letter from my alarm monitoring company and our pest control company telling me that, due to rising business costs (incurred with supply costs, employee healthcare, regulatory compliance, employee training, etc.), they will be implementing price increases. Of course, they want me to continue to use them to service my office; and I have no reason to change because everyone is likely handling the financial matters the same way….except for us.

Faced with the escalating costs of maintaining a practice and...

Editor's note: Dr. Davids' extended-length letter can be read here.



Podiatric Residency Crisis - Where are We? (Ivar E. Roth DPM, MPH)

From: Michael M. Rosenblatt, DPM

Dr. Ivar Roth presented an opportunity for training for some DPM graduates who were not matched for residencies. Dr. Roth agreed to provide "excellent training" and also payment for recent graduates. This is a generous and deeply kind offer. Dr. Roth was "disappointed" and more than a little angry when those people he accepted placed a higher value on residency.

This puts the issue of a clerkship/associateship training vs. active, real residency on the table. One of the issues involved is whether or not...

Editor's note: Dr. Rosenblatt's extended-length letter can be read here.



RE: Podiatry's Secret Problem (Victor S. Marks, DPM, MPH)

From: Richard M. Maleski, DPM

Is it mere coincidence, clever manipulation by the editor, or some Karmic influence that put the posts about podiatry's secret problem and 104 graduates not having residencies together in the latest PM News?

I read Dr. Marks' retort to Dr. Moskowitz's concern about billing for routine services, and agree with Dr. Marks, the aging of America with the resultant morbidities that age brings should be a major focus of...

Editor's note: Dr. Maleski's extended-length letter can be read here.



RE: Best Laser for Nail Fungus and Verrucae? (David Zuckerman, DPM)

From: Scott Day CEO Hyperion Medical

Dr. Zuckerman fails to mention that the Diowave laser (he represents and sells) is not FDA-approved in podiatry for pain, nor is it FDA-cleared for treating onychomycosis or warts. The protocols he has personally established are only recently developed and have not been validated  by the FDA for safety or efficacy.

On the other hand, the HyperBlue 1530 laser has been clinically validated to be safe and effective and FDA-cleared in podiatry for verrucae (periungual, subungual, and plantar), matrixectomies, neuromas, and to clear nails in patients with onychomycosis.

The HyperBlue 1530 protocols for onychomycosis and warts have been proven over the last 7 years in Europe and 2.5 years in the United States. Additionally, the HyperBlue 1530 features all the other benefits Dr. Zuckerman alludes to in his response. This includes a company which prides itself on integrity and customer service.

Scott Day, CEO Hyperion Medical,  Dallas, TX,



RE: May is National High Blood Pressure Month

From: Michael Brody, DPM

May is National Health and Blood Pressure Education month, and CMS is currently involved in an outreach educational program for patients to help improve monitoring and management of high blood pressure. Among the educational programs that are being promoted to patients is encouraging patients to visit their primary care providers for cardiovascular screening.

With this educational program that is being promoted by CMS, it is a good time to remind all doctors, primary care and specialists alike, of the importance of measuring a patient's blood pressure in the office. With the prevalence of high blood pressure, the need for this item to be included in meaningful use is underscored. I regularly present lectures to doctors on meaningful use and the vital signs measure is one that is often touched upon. It is quite common for a member of the audience to come up to me after the lecture and tell me a story of how they detected dangerously high blood pressure while taking steps to meet meaningful use. The doctors who have encountered patients with abnormally high blood pressure are now regularly checking the blood pressure of their patients, and preforming this test at a rate that exceeds the threshold required by meaningful use.

I encourage all doctors of all specialties to check patients' blood pressure on each and every visit. You will be providing very valuable service to your patients.

Michael Brody, DPM, Commack, NY,



RE: Coding Verification Reviews for Custom Fabricated AFOs (Robert Gaynor, DPM)

From: Paul Kesselman, DPM

First, I suggest that in the future, the use of "brand or proprietary name" devices not be used in what should be an educational forum. The manner in which the original letter to the editor was written suggests that instead of attempting to educate our colleagues, it was used as a tool to provide a competitive edge for one product over another. This has resulted in many podiatrists being unduly concerned over their risks of being audited for their current purchasing practices.

Second is that research on this matter reveals that Dr. Gaynor is the owner of DiaFoot and his company advertises a PDAC-approved L1970 device on DiaFoot's website. A disclaimer by Dr. Gaynor...

Editor's note: Dr. Kesselman's extended-length letter can be read here.



RE: Is it Time to Bring Back Chiropody? (H. David Gottlieb, DPM)

From: Neil H Hecht, DPM

The root words of chiropody are “chiro” for hand and “pod” for foot.  The original chiropodist was actually a “hand and foot practitioner”. (In Ohio, the practice act even allowed hand care by the podiatrist when I grew up there. I believe this has been changed.)


A chiropractor is a practitioner who uses his hands, thus the same root “chiro”. The two doctors were often confused by the public before 1959 when Doctor of Podiatric Medicine was adopted as the universal degree for podiatrists. (For historical reference, at that time, podiatrists had been designated by many doctorates, e.g. DSC, PodD, DPM, etc., depending upon which school awarded the degree.)


I don’t believe we “DPMs” need to have a sub-specialty of “chiropodist” as we perform all our procedures on the lower extremity only. I do believe we need to be “MD”, as this is how we actually function, regardless of whether we do “C&C”, taping, injections, therapy, prescribing, surgery, or any other medical or surgical intervention for treatment of the human body, AND this is what the public and the government understands.


Neil H Hecht, DPM, Tarzana, CA,



From: Robert Bijak, DPM


I will accept criticism but not lies. Dr. Gurvis said that I hate orthotics. I do not want this falsehood attached to my name. I may challenge orthotic theory and/or study protocol, but I have NEVER said I hate orthotics. 


As for his claim that I disparagingly call orthotics arch supports, I maintain that IS their main function, and therefore a correct operative definition. If he chooses to euphemize the devices and call them antipronatory decelerators, talonavicular orthtoics, contact lenses for the feet, or whatever to assuage his ego, that's his choice.   


Robert Bijak, DPM, Clarence Center, NY,



RE: Sterilizing Bits Between Debridements (Alan Meyerberg, DPM)

From: Bryan C. Markinson, DPM

The recent discourse on the hazards of nail drilling leaves me perplexed at the seemingly large degree of ignorance on this subject.

At the recent Council for Nail Disorders annual scientific conference, I had the opportunity to present some data on workplace exposure to bioaerosols in nail dust. A large study of 15 podiatry clinics in Ireland revealed the following bad and mediocre news:

Coggins, et al., Workplace Exposure to Bioaerosols in Podiatry Clinics, Ann. Occup. Hyg., pp 1-8 on behalf of British Occupational Hygienic Society, December 2011

• Respirable aerosols (80%) of the dust contained yeasts and molds (65%) and fungi (87%)...

Editor's Note: Dr. Markinson's extended-length letter can be read here.



RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)

From: Estelle Albright, DPM

You have got to be kidding me! Not sterilizing/changing sterile bits between patients? That's like a dentist not changing drill bits between patients. This is the kind of thing that gives podiatry a bad name. It is, however, a way to ensure a continuing annuity of nail fungus patients into perpetuity. And who is still using Dremels, anyway?  They belong in your woodworking kit, not your podiatry office.

Estelle Albright, DPM, Indianapolis IN,

OSHA has numerous regulations on this, and grinding nails is a health hazard. Grinding nails is a practice that should be stopped along with the utilization of dirty whirlpools. It is a good idea to use an instrument rinse, manually scrub the instruments, use an ultrasonic cleaner on the instrument for an hour with a sterilization solution, and then autoclave. The autoclave used should be regularly maintained and have weekly biologic and spore testing performed as well. 

Daniel D. Michaels, DPM, MS, Frederick, MD,



RE: ABPS Name Change (M. W. Aiken, DPM)

From: Richard Gosnay, DPM, Tip Sullivan, DPM

I am quite happy to be a podiatrist. I am often dumbfounded by the belittling euphemisms that some of my colleagues use for our profession, as if there is something about our specialty that is inferior. So, I answered the first question on the ABPS questionnaire, "Yes, I am satisfied with the name American Board of Podiatric Surgery." I also answered the later question in the affirmative. I am strongly in favor of the name change to the American Board of Foot and Ankle Surgery.

Podiatry includes many facets. One of them is foot and ankle surgery. This board certifies competence in foot and ankle surgery. There is nothing pejorative about recognizing this. And there is no particular reason why the word, podiatric, needs to be in the name. The proposed name is descriptive and honest. I am mostly in favor of the name change because if we do not use this name, how would we feel if another profession takes it? Suppose there comes a time when nurse practitioners decide to emphasize nail procedures, orthotics, skin biopsies, wound care, and fracture care. And suppose their profession certifies their new-found niche with a board. How would you feel about practicing in the same building as a nurse practitioner who is certified by the American Board of Foot and Ankle Surgery? I think that the proposed name change is prudent and would protect the interests of our profession.

Richard Gosnay, DPM, Danbury, CT

As a profession, we had better be more concerned about our own members rather than what we call ourselves. I have recently learned of a 3-year residency program in Rancho Cucamunga, CA that has had to close down for financial reasons, leaving the residents there in a bad way. These people are our future regardless of what we call ourselves. I think we have sorely misplaced our priorities when we can debate and discuss issues like a name change while our residents and our programs, who in essence are our future, are not getting our attention and support!


Tip Sullivan, DPM, Jackson, MS,



RE: Keeping Track of Inventory for Separate Offices (Charles Morelli, DPM)

From: Farshid Nejad, DPM

Traknet EHR offers a robust inventory tracking system with the use of barcodes. You can have a single database that you can access from different offices. It will allow you to set prices and notify you when you are running low on a product.

Farshid Nejad, DPM, Beverly Hills, CA,



RE: ICD-10 Preparation (Edmond F. Mertzenich, DPM, MBA)

From: Harry Goldsmith, DPM, Michael Rothman, MS, DPM

"What bothers me is that for a coding system that has been used internationally for many years, there are so few sources in this country to get the actual codes, let along information on how to code properly. It seems to me that there are a few proprietary companies out to make a good profit from this doom and gloom."

CMS has for several years now offered not only the complete draft ICD-10-CM database (currently 2012), but also ICD-10-CM guidelines, GEMS (sort of crosswalk), and a whole host of ICD-10-CM information…for free on its site.  What you get from commercial products is the same thing in a prettier, more convenient (maybe) package along with expert commentary, pointers, etc.


Go to for a tremendous amount of free information.


NOTE: My previous response listing the estimated costs for implementation of ICD-10 and how those costs are broken down is still relevant. It will be a costly transition for practices.


Harry Goldsmith, DPM, Cerritos, CA,

Ah, another government conspiracy, just like that foreign metric system thing. Just because every country in the world uses ICD-10 and it's backed by the WHO doesn't mean the good old USA has to. 

Michael Rothman, MS, DPM, Skokie, IL,



RE: Overburdened by Paperwork (Howard Fox, DPM)

From: Frank Lattarulo, DPM

I read with interest the response by Dr Fox. I too, like Dr. Fox, would have a brief patient info sheet, then a privacy policy. I would see the patient in the consultation/treatment room also, and do a more complete H&P. I would document these findings in my chart and then dictate my complete and final note. It's pretty efficient and highly effective. However, now that I have made the jump into EMR, I somewhat feel Dr. Borreggine's pain.

Take medications as an example. To meet meaningful use, it's simply not enough to list medications. You must list the complete list of meds taken by the patient, as well as dosage and frequency. In some patients, that can be quite a list. Once these patients return to the office, it's...

Editor's note: Dr. Lattarulo's extended-length letter can be read here.



RE: Switching to Comcast for Phones and Internet (Barrett Sachs, DPM)

From: David Hettinger, DPM

I switched to Comcast a couple of years ago and have not had any problems at all. The phone service is good with a flat rate for unlimited calls in the U.S. (check your specific provider though). The Internet is VERY fast, but again, this depends on how many people are using it, and how far you are from the main hub. The main hub at my office happens to be on the roof right above my back door. It's still faster that anything I ever got from AT&T. All I can tell you is that I personally recommend it.


David Hettinger, DPM, Wheaton, IL,



RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Alan Sherman, DPM)

From: Eric J. Roberts, DPM

In response to those who think we should remain “podiatry” and “podiatrists,” I pose the following analogy: Would you, who call yourselves podiatrists, be happy if you were called a chiropodist? Would you be happy to hang a sign outside of your office that said “Chiropody Office”? You have to realize we eventually progressed from chiropody to podiatry. 

TODAY, we are moving from podiatry/podiatrist to foot and ankle specialists, foot and ankle surgeons, and podiatric clinicians/physicians. I can understand those of you who are proud to call yourselves podiatrists. Let me remind you, in case you forgot, what our degree stands for - DPM: Doctor of PODIATRIC MEDICINE, not Doctor of Podiatry. Our residency programs receive the designations: PM&S or new PMSR: Podiatric Medicine and Surgery, or Podiatric Medicine and Surgical Residency. 

As a new generation of DPMs graduate and infiltrate the work force, you will find that many of us (myself included) are seeing the differences in how people respond to the word “podiatrist.” Many of the public see podiatrists as people who cut nails and trim calluses, but most are surprised when they find out their foot and ankle surgeon is one of those people. As a wise man once told me, “Perception is 9/10ths of reality.” How do we want to be perceived as we move ahead?


Eric J. Roberts, DPM, Forest Hills, NY,



RE: Walk for the Cure...NOT! (Robert Scott Steinberg, DPM)

From: Arthur Gudeon, DPM

I toe-tally agree with Dr. Steinberg. The Komen organization, even though overwhelmingly forced to recant their position, should be ashamed of having bowed to political activists at the expense of women's health in the first place. I'm also aware of the lawsuits they've generated against well-meaning charitable organizations that tried to use the "for the Cure" statement in raising funds for various breast and other cancer research walks.

The Komen Foundation also happens to have a much higher percentage of their donations going for "administrative" costs than many other legitimate charitable organizations, such as the Lustgarten Foundation for Pancreatic Cancer Research, whose administrative costs are FULLY covered by Cable Vision, so ALL donated funds go towards research and development. I've played in a tennis event called Play for Pink for the past few years, with donated funds going to Komen. I'll be asking them to change to Play for Purple from now on, with funds going to Lustgarten or the Pancreatic Cancer Action Network ( !


Disclaimer: I do have a personal interest in the Lustgarten Foundation, as my wife, Susan, has been bravely battling pancreatic cancer for over 1 1/2 years now, and I'd like research to find a way to keep her around for many more years.

Arthur Gudeon, DPM, Rego Park, NY,



RE: Our Challenges: Innovate, Grow, or Wither Away? (Michael M. Rosenblatt, DPM)

From: Robert Kornfeld, DPM

Drs. Markinson and Rosenblatt inject a rationale that the entire profession needs to pay attention to - specifically, the reference by Dr. Rosenblatt to lifestyle-induced degenerative diseases. This is exactly what the focus of integrative medicine is - to intervene on behalf of epigenetic influences on health and then support the body to heal itself.

There are many income streams that are available when practicing this way and...

Editor's note: Dr. Kornfeld's extended-length letter can be read here.



RE: Transition from In-House to Billing Agency (Cedrick Cooper, DPM)

From: Donna Bieze

The transition can be seamless. In our experience, there is no interruption in cash flow. It usually takes a few weeks to get all of the EDI ERA agreements in place. It is a fairly easy process that a billing service can handle completely for you.


One good reason to choose a billing company is that they devote 100% of their time to billing. They can't be pulled to work the front desk or to take patients to the treatment rooms. Follow-up on denied claims is very important. This is one area that seems to get neglected when billing is done in-house because it is so time-consuming.


It is best to go with a company that knows the ins and outs of podiatry billing. 

Donna Bieze, Revenue Solutions,



RE: Charging for Paperwork (Michael J. Hodos, DPM)

From: Lori Preece

We too had been hesitant to charge for completion of paperwork but began to do so 3 years ago because the requests were becoming burdensome. We display our cash prices for completion of paperwork and it is explained in our written financial policy which each patient receives at the initial visit. We have a charge for initial paperwork completion and then we have a minimal charge for renewal types of paperwork, not limited to handicap parking placards from the DMV and disability paperwork for employers.

I think we must have been late getting around to charging for paperwork completion because not a single patient has complained about our policy. Charging for these types of services has taken the irritation out of this constant request in our practice.

Lori Preece, Office Manager, Dr. Jeffrey H. Katz,



RE: Bone Mineral Density Testing (Robert Bijak, DPM)

From: Sloan Gordon, DPM

One wonders why insurers and others mock our profession. We can't agree, we don't have standardized EBM, and we chastize each other publicly in listservs such as this one. Bone densitometry using the calcaneus is nothing new. See:

I believe that if you see a patient with significant osteopenia in the foot and ankle, the DPM has a right, perhaps even an obligation, to treat his/her findings. In addition there is evidence that biphosphanates (Fosamax, Actonel, Forteo) are useful in treating Charcot joints. I know we use them successfully pre- and post-operatively in our Charcot reconstructions.

I am so tired of reading what we CANNOT do by our colleagues; how about using our complete education and training, and thinking out of the box. I am so tired of our negativity towards one another. We are not one another's enemies. And, yes, if you have a calcaneal bone densitometer, you should get paid for your services.  

Sloan Gordon, DPM, Houston, TX,



RE: Bone Mineral Density Testing (Joe Agostinelli, DPM)

From: Elliot Udell DPM


Bone density scans generally evaluate the bone density of the hip and spine. Hence, it would seem reasonable that an orthopedic surgeon who owns the machine and takes the test would be reimbursed for taking it, while a podiatrist would not, because the anatomic areas studied are clearly out of scope for podiatry in every state.


When evaluating a radiograph of the foot where osteopenia is noted, not only is it prudent to send a patient to a radiologist for a bone density scan, but it is imperative that we send the patient to a blood lab to evaluate serum vitamin D 25 levels. In our office, a month does not go by where do not pick up a case of a patient presenting pedal bone loss who was unaware that he or she had dangerously low levels of vitamin D.


Elliot Udell, DPM, Hicksville, NY,



RE: Bone Mineral Density Testing

From: Joe Agostinelli, DPM

In the orthopaedic practice that I work in, we are fortunate to have many ancillaries, such as MRI, vascular analysis, physical therapy, and bone mineral density testing (DexaScan). All of these ancillaries provide for reimbursement in the state of Florida for DPMs except the bone mineral density exam. My orthopaedic surgeon partners are reimbursed for this.

I know that many of you treat patients who need a bone mineral density examination to assess for healing of bone reconstructive surgeries and to assess risk for fracture. We also see patients with moderate to severe osteopenia as seen...

Editor's note: Dr. Agostinelli's extended-length letter can be read here.



RE: Holiday Staff Bonuses (Lloyd Nesbitt, DPM)

From: Lynn Homisak, PRT

I want to weigh in on this from a consulting, staff, and personal perspective...and I couldn't have said it any better than Dr. Nesbitt! Wages, bonuses, and benefits do not necessarily provide employee job satisfaction, but it is the absence of them that can lead to their dissatisfaction - especially if they are given one year...then stopped the next! An end of year bonus is a "gift" and we give gifts to people whom we want to make happy. Bonuses should be given to tell staff they are appreciated.

Doctors, if you do not appreciate your staff, or feel they don't appreciate YOU, do yourself a favor and get new staff. However, if you do appreciate them, I agree 100% with Dr. Nesbitt - willingly and unbegrudgingly bonus them for their year-round efforts. Gifts given from the heart and rooted in appreciation will be returned to you in rewards far more valuable than the dollars you give! I speak to you from years of experience!

Lynn Homisak, PRT, Renton, WA,

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