04/27/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
From: Richard A. Simmons, DPM
I have used Cetylcide-II for more than 20 years without staining. Two things to always do: 1) use distilled or de-ionized water and 2) use “Anti-Rust Powder” that is manufactured by Gordon Laboratories (one oz to one gallon of solution).
Richard A. Simmons, DPM, Rockledge, FL
04/24/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar Roth, DPM, MPH
The policy that we instituted requiring a credit card for first time patients has worked extremely well. Our front desk can figure out when an elderly patient says they do not have a credit card and they act accordingly. This policy is for the tire kickers or potential new patients who abuse the system. We used to get a few that would give us a false credit card number. Now that we actually charge the card beforehand, we know if the card is good or not. These tire kickers know we are on to them and hang up or do not make an appointment, which is good.
Our no-show rate with our new policy for new appointments is about zero now. As far as us being on time, we are. We run a tight ship.
One caveat, I run a concierge practice where we do not take any insurance.
Ivar Roth, DPM, MPH, Newport Beach, CA
04/24/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell, DPM
Many doctors and dentists penalize patients for missing appointments irrespective of whether it is the first or a subsequent visit. One rheumatologist in my area is even bolder. If a patient misses a single visit, he sends them a letter letting him or her know that he or she is persona non grata in his practice and should find another rheumatologist. I know he does this because two patients recently were upset at me for referring them to this doctor. Because of his behavior, I am now reluctant to refer any more patients to him.
Several years go, I missed a dental appointment and his office manager called me and told me they are charging me a hundred dollars. I let the dentist know that I would pay him what he asks, but would no longer use his services. He retracted the fee and since that time he has done a number of crowns for me as well as other dental work. Had he gotten the hundred dollars out of me, he would have lost thousands.
The bottom line is that if you are prepared to penalize a patient for missing a visit, you should also be prepared to suffer the consequences of angering a patient. In my practice, when this happens, I bury my ego, give up being right, and continue rendering podiatric care to my patients.
Elliot Udell, DPM, HIcksville, NY
09/07/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Podiatrists and Hospital Privileges
From: Bryan C. Markinson, DPM
The notion that non-surgical podiatrists do not need hospital privileges keeps popping up in the discussions involving the residency crisis. This immature notion is only propagated by selfish colleagues, period. While our profession, colleges, and APMA markets podiatry as the "guardians of foot health," I ask the following: Doesn't a diabetic foot specialist, who does not do surgery, have a need to admit patients for infections, wounds, etc.?
Does the removal of a metatarsal head or toe amputation require 46 initials after your name? And what of the poor lot of us who have distinguished ourselves in sports medicine,...
Editor's note: Dr. Markinson's extended-length letter can be read here.
09/04/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Where Podiatry Has Earned International Parity (H. David Gottlieb, DPM)
From: Narmo L. Ortiz, Jr., DPM
While I acknowledge Dr. Gottlieb's example of parity among national and international foot and ankle surgeons in academia, the fact has been and continues to be that, economically, there is no parity at all.
Parity will be achieved when the DPM degree is reimbursed the same as the MD and DO degrees.
Narmo L. Ortiz, Jr., DPM, St. Petersburg, FL, nlortizdpm@embarqmail.com
09/03/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Where Podiatry Has Earned International Parity (H. David Gottlieb, DPM)
From: Samantha E. Bark, DPM
Thank you, Dr. Gottlieb for publicizing the Baltimore Limb Deformity Course (BLDC). I agree it is one of the best lower extremity courses in the world. However, I have not been to every lower extremity course in the world, so I cannot say it is THE best, just ONE of the best.
The attendees do sit at mixed tables of podiatrists and orthopedic surgeons, and many of the table (lab) assistants are podiatrists who are former fellows. The conference and labs have a combined audience of podiatrists and orthopedists until the last day when we split into two groups. There is a lecture/lab for foot and ankle deformity correction and one for femur and tibia. This year the focus of these split groups was on using the "Bone Ninja" iPad App. Attendees are free to pick either lecture/lab. Another striking difference this year is the absence of the acronym CORA. The directors of the course have painstakingly taken years to figure out how to explain deformity correction using new simpler terms and have written a new book using these simpler terms. The principles are the same.
I also agree that there is parity in the form of intellectual equality at the meeting, in the lectures and labs, but once the podiatrists return home, they are back to their reality. Some already have advanced practices, like Drs. Lamm and Siddiqui, whereas others continue the fight to obtain further privileges and change referral patterns.
Samantha E. Bark, DPM, Falls Church, VA, krabmas@yahoo.com
09/02/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Where Podiatry Has Earned International Parity
From: H. David Gottlieb, DPM
Right now in Baltimore, MD [August 28 - September 3] is what I consider the best foot and ankle course in the world. And a whole host of podiatrists and international orthopedic surgeons agree. At this conference, the Baltimore Limb Deformity Course, orthopedic surgeons from all over the world meet for 6 or 7 days of intensive training, didactics, and hands-on workshops dealing primarily with lower extremity deformity correction.
Lecturers include not only world renowned orthopedic surgeons, but also world renowned podiatrists such as Guido LaPorta, Bradley Lamm, and...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
08/05/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Economical Digital X-Ray System or Processor (Birute Balciunas, DPM)
From: Paul Shapiro, DPM
I have used the 20/20 imaging digital x-ray unit for the past 2 1/2 years after relocating to a new office. After the yearly support fee, the unit is virtually free of cost to use. I have been very pleased with the unit and its improvement over plain films. No chemicals, no films, and no dark room necessary. Films can be viewed 24/7 over the Internet. The company has always been available for support when needed.
Paul Shapiro, DPM, Phoenix, AZ, shapsy1@cox.net
07/29/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Discontinuing Diabetic Shoe Program (Neil H Hecht, DPM)
From: Deborah Wehman, DPM
This is just another example of how a good program became a victim of fraud. We all know that the program has been abused since it was never meant to be a free pair of shoes for every diabetic every year. I'd be willing to bet that no more than about 10% of my diabetic patients truly need the shoes. I figured it was only a matter of time before it would have to be stopped because the government can't afford to buy a $350+ pair of shoes for every diabetic each year.
Deborah Wehman, DPM, Richmond, IN, dswehman@comcast.net
07/26/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Source for Accu-Mold Substitute (Joan Schiller, DPM)
From: Robert Teitelbaum, DPM
Otoform-K, offered by Alimed Co., and seen in some other "sports medicine" catalogues is my alternative of choice. It is manufactured in Unna, Germany (as in Unna boot). Unna is stamped on the tub.
Robert Teitelbaum, DPM, Naples, FL, Mfvandange@aol.com
07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Setting the Record Straight on Debridment of Calluses in Diabetics (Alan Sherman, DPM)
From: David Armstrong, DPM, MD, PhD
Just to let you know, we responded directly to Dr. Bernstein months ago directly in the journal Diabetes Care.
David Armstrong, DPM, MD, PhD, Tucson, AZ, Armstrong@usa.net
07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Source for Accu-Mold Substitute (Joan E. Schiller, DPM)
From: Christopher Case
PediPlast® Moldable Podiatric Compound has long been a popular alternative to Accu-Mold for the creation of custom digital devices in less than 5 minutes.
To order, or get more information, contact PediFix or the major industry distributors, including Gill, Moore, and Schein, all of which have PediPlast in stock for immediate delivery.
Christopher Case, PediFix Footcare Company, Christopher.Case@pedifix.com
07/13/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
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, jtdavisco@yahoo.com
07/10/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: TRAKnet Service Agreement
From: Joseph Cortez, DPM
For those of us who do not feel comfortable giving your credit card information and having it on file, TRAKnet does offer a pay by check option. Payments must be either for 6 months or one year. In order to pay by check, you would need to fax over a signed copy of the service agreement along with the check. I assume mailing the check with the service agreement would be appropriate.
Also ,I am trying to negotiate a lesser fee for updates and to connect to their servers, with a fee charged for technical support when you need it. I do not see why anyone would pay for technical support that they may or may not use every month, unless you like throwing your hard-earned money away.
Joseph Cortez, DPM, Simi Valley, CA, jmcdoc@roadrunner.com
07/03/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: First Coast Disallows CPT 76942 for Podiatrists
From: Marc Katz, DPM
Here is the link and some of the points that have been issued by First Coast Medicare regarding CPT 76942. Those who scrupulously used this code for a small portion of your patients to guide injections will no longer be able to use the code in pretty much all cases. You can thank our colleagues who use it on every injection in the office. It seems to just be the story of podiatry! And, of course, of all specialties, podiatry is one of the only ones specifically mentioned, "Needle procedures of the foot by podiatry or other specialties. (Most of these interventions are standard office based needle procedures and not special procedures performed on a radiology suite)."
A few other points from the link: "Though MAC J9, based on the low quality of evidence in the peer reviewed literature, could deny many of these billing situations as services not meeting the reasonable and necessary threshold for coverage, there is concern with beneficiary liability. CPT® 76942 is valued in the 220 dollar range, whereas the majority of the office-based procedures outlined above suggest value in a range from 0 to 40 dollars. (This is based on reference value mapping of CPT® codes such as the value assign for CPT® code 76937 Ultrasound guidance for vascular access). In summary, it is the expectation that physicians utilizing ultrasound guidance for standard office based needle procedures will not code separately, or alternatively, bill the unlisted code CPT 76999."
Marc Katz DPM, Tampa, FL, dr_mkatz@yahoo.com
06/27/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
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, podtexdoc@aol.com
06/27/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: TRAKnet Charges (Marge Portela, DPM)
From: Joseph Cortez, DPM
It is highway robbery. I over-estimated them and assumed they would not take advantage of a government-mandated situation. $3,000 a year for updates and to connect to their servers to e-prescribe? You have to be kidding me. How many updates does that guarantee me a month? I find it ridiculous that they say you will not be able to use your TRAKnet if you do not have a service agreement. It seems to me they are putting the pressure on their clients, forcing them to comply or be left out in the cold.
Joseph Cortez, DPM, Simi Valley, CA, jmcdoc@roadrunner.com
06/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
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.
06/17/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Time for EBM Study on Custom Orthotics
From: Carl Solomon, DPM
I appreciate the ongoing discourse about biomechanics theory and who’s right/who’s wrong. But I’m still waiting to see ANY decent controlled study in our literature.
When will one of our “experts” please take a couple hundred patients, and divide them into two groups? Have one group use “custom” orthotics and the other use OTC inserts for some condition (heel pain, metatarsalgia, whatever). After some period of time, maybe a year, look back and see whether there’s a statistical difference in outcomes. How about the same study (but longer than a year) with custom orthotics vs. no orthotics on patients with early hallux valgus to see if there's REALLY any effect upon progression of the deformity.
Until that’s done, we are at the mercy of insurance companies who (rightfully) say our “custom” orthotics are unsubstantiated. Worse yet, we are denied the ability to refute the ads that are now popping up for commercial orthotic stores who claim that theirs are “300% better” than podiatrists’ custom orthotics!
Carl Solomon, DPM, Dallas, TX, cdsol@swbell.net
06/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Facility Fees (Tip Sullivan, DPM)
From: Martin V. Sloan, DPM
There is likely no rational explanation for fee discrepancy, just as there is no rationale for other areas of reimbursement. Here's another: Medicare will NOT pay for functional orthotics when medically necessary, yet they WILL pay for accommodative diabetic inserts ANNUALLY when medically necessary. So, over a ten-year period in a diabetic's life, they will pay approximately $2,000 for A5513 (@$200/year) but they WON'T pay $400 for a pair of well-made orthotics that should easily last ten years.
Martin V. Sloan, DPM, Abilene & Rockwall, TX, mvs32154@gmail.com
06/07/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2B
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.
06/04/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Medicare Calling Patients
From: Name Withheld (MA), Name Withheld (NY)
I had a very similar conversation with one of my patients a couple of weeks ago. She informed me that Medicare called her and asked her why she sees me. I find this very troubling as well.
Name Withheld (MA)
A colleague of mine had the same issue, but it progressed from simple questioning to audits, to now an indictment. Be careful, because it seems like a fishing expedition on the part of Medicare.
Name Withheld (NY)
05/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
Re: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Lynn Homisak, PRT, Carl Ganio, DPM
I have to be honest, I cringed when I read your post because if what you say is true…that you suspect the receptionist and OM are in cahoots and deliberately not scheduling patients…and that they did not accommodate the diabetic caller with a same day appointment (even though they were instructed to)…these are NOT the people you want working for you. In fact, it sounds more like they are working against you! How many other potential patients (besides your “planted call”) were turned away? To answer your question, yes, there is a way to record phone calls for “quality control” AND quality training purposes.
I have never been a proponent of “spying” on staff by using their mistakes and errors as a means of reprimand. I am more of the belief that...
Editor's note: Ms. Homisak's extended-length letter can be read here.
My advice would be to replace that person or persons, as they are becoming too territorial with your patients. They have a sense of entitlement that empowers them to act in their own best interest...not yours. I had a patient sheepishly return to my office after having surgery with another podiatrist. She told me, that when she called my office for a consultation, the front office told her "Doctor Ganio no longer does surgery." This particular ex-employee did not like all the additional work associated with scheduling a surgery. It is undetermined how many people she misdirected in this manner.
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz
05/24/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Staff Makes it Difficult to Get Appointments
From: Michael Robinson, DPM, MPH, JD, Elliot Udell, DPM
It is very easy; your staff doesn't care about your policies or practice needs. It is time to replace them and get staff who listen and do what you want. This advice is short, not sweet, but it is what you need to do.
Michael Robinson, DPM, MPH, JD, Brookline, MA, drmrob@aol.com
The scenario that you describe makes my "blood boil" because many times I have referred patients and close relatives to specialists for urgent medical care and some front office person answering the phone refused to give the person a timely appointment. I still remember referring a patient to a hematologist for an urgent visit and the patient was told that the earliest appointment was in three months. I met this doctor a few days later in my local hospital and he lamented that his office was very slow and he can't figure out why.
The bottom line is that it does not take staff too long to realize that they have a vested interest in keeping a practice slow. It's less work for them. They will have fewer patients to contend with, less paperwork, and they will take home the same pay check irrespective of whether the office is busy or slow. The only way to address the issue long-term is to either monitor every call or offer them some kind of financial incentive that makes it worth their while to book patients.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
05/14/2013
RESPONSES / COMMENTS (NON-CLINICAL)
RE: Flex OA Shoe (Roy H. Lidtke, DPM)
From: Robert Scott Steinberg, DPM
I want to thank Dr. Lidtke for engaging in this discussion. I have read his extended-length letter. Since it was not mentioned in Dr. Lidtke's letter, I am left to assume that the OA shoe does what it does without the aid of any sort of foot orthotic. Am I correct? And, that the correction/posting is internal to the shoe?
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com
