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RE: Diagnostic Ultrasound (Michael Forman, DPM)

From: Thomas Graziano, DPM, MD


I submit that those who use ultrasound for plantar fascial and neuroma injections are doing so for billing purposes. I'm not being critical.  It's fine to bill for advanced technological modalities if you have them at your disposal. But please don't do so under the guise that ultrasound-guided injections are more precise or accurate for these conditions. Let's not kill a mouse with an elephant gun. How about palpating the medial calcaneal tuberosity or the distal intermetatarsal space respectively prior to giving the injection. I think that a "series of 3 steroid injections" are bound to hit their target, even without using ultrasound guidance. Some "with and without" ultrasound guidance outcome studies are probably in order.

Thomas Graziano, DPM, MD, Clifton, NJ,

Other messages in this thread:



RE: Vasyli Medical Affiliates Program  (Eric Simmons, DPM)

From: R. Andy Dale, DPM, Michael Forman, DPM

This is the company that makes Orthaheel sandals and shoes. I find this is a good sandal with a built-in arch support. About every female patient I see, starting in spring, asks me about sandal recommendations. I contacted Orthaheel and they sent me a booklet with pictures of different types of Orthaheel sandals. They send you a sticker to put on each booklet with a coupon code. If patients put this coupon code into the website, they get free shipping and the doc gets 10% of the cost of the sandals the patient buys. Orthaheel also sent me two sandals to show patients, and patients appreciate that. 

Last year, Orthaheel sent me a check for about $40. It's not much, but if it helps to get patients better, that's all that counts. I find these sandals help heel pain and PT tendinitis patients the most. Vasyli has a program where you can sell their shoes and sandals in your office too. If you do that and sell a certain number of shoes/sandals, you are sent a free stand with different shoes and sandals. But, you have to store the different models and sizes of shoes somewhere. I've been thinking of starting to sell the Orthaheel shoes. The Orthaheel shoes can be bought on websites other than Orthaheel, but they are older models, I think. I've heard of sandals made with a custom orthotic insole which would likely help more than Orthaheel, but of course costs more.

R. Andy Dale, DPM, Clarksburg, WV,

Dr. Eric Simmons mentions that a doctor can receive a 10% rebate on any product purchased by a patient whom you referred to them. I believe this may be a violation of the Stark Laws. You cannot  receive anything of value for making a referral. I believe that Vasyli is headquartered in Australia. They may not have the same laws as we do in this regard. JUST DON'T.

Michael Forman, DPM, Cleveland, OH,



RE:  Inexpensive Cast Cutter (Tom Fitzsimons)

From: Ross E. Taubman, DPM, Joseph Borreggine, DPM

PICA’s policy does not set the standard of care, and as such, does not tell our policyholders what they can or cannot use in their practice. Rather, PICA’s policy covers our policyholders for the entire scope of practice in a given state. That scope of practice is determined by the individual’s state licensing board. As long as a policyholder has a valid license and is practicing within their scope of practice, PICA will cover their claims, as long as all other policy provisions are met.

Ross E. Taubman, DPM, PICA President and Chief Medical Officer,

Here is a malpractice case on the improper use of a cast it really does matter what device you use to remove a cast...if you use it improperly and cause an injury, then you may be liable.

Joseph Borreggine, DPM, Charleston, IL,



RE:  SudoScan (Howard Dinowitz, DPM)

From: Lloyd S. Smith, DPM

As someone who has spent almost 20 years reviewing code values for APMA at the RUC, I wonder how our colleagues are coding for this new technology. Typically, CPT and RUC lag behind the adoption of new procedures and devices. In reviewing the information on the company website, I struggle trying to find an appropriate code and, in turn, determining a value for the procedure.

Is it part of an EM visit? Is it worthy of a new code? Is there an existing code that could be used? If it were to get a new code, based on the descriptions I have read, the value would be minimal. If the value were minimal, would use of the technology plummet, or would the clinical value override minimal reimbursement. I am not judging the technology, simply asking a few questions.

I will also add that with the ability of CMS and RUC to rapidly review changes in coding frequency, scrutiny of the codes being used to bill for a SudoScan will occur quickly and will impact those codes by requesting a code proposal, arbitrarily reducing values, creating local policy restrictions and/or initiating audits. 


Lloyd S. Smith, DPM, Newton, MA,



RE: Reliable Billing Company

From: Richard H. Mann, DPM, Jennifer Thomas Griffin, DPM, Tina Del Buono, PMAC

I use Physician Claim Corp. ( I am quite happy with their work.  I have found them to deliver great customer service, coupled with accurate, prompt submissions. I highly recommend them.

Richard H. Mann, DPM, Delray Beach, FL,

I recommend Stat Medical in Dallas, TX. Lee Ann has been billing for over 20 years. She is extremely knowledgeable. She is also a bulldog and will stay on a problem until resolved. Her staff is great. Give her a call. You will not be disappointed.

Jennifer Thomas Griffin, DPM, Malakoff, TX,

I highly recommend Independent Networking Group ( The executive director is Mary-Ellen Schimmoller. The staff at ING are a cut above and their ethical standards rate A+. They know their stuff when it comes to podiatric billing.


Tina Del Buono, PMAC, Santa Rosa, CA,



RE: NY Times Article

From: Richard Rettig, DPM

This lay article from the NY Times describes a real medical study (British Journal of Sports Medicine) that was undertaken to determine the roll of biomechanics in choosing running shoes, and its effects on injury rates. 

It raises the question as to what a similar quality study would show regarding foot orthotics.  I suspect I know the answer.

Richard Rettig, DPM, Philadelphia, PA,



RE: A Message to the Lost 92 (Name Withheld)

From: Ira Baum, DPM


Everyone should read Name Withheld's letter in its entirety. His story is sad and strangely optimistic. He, as many others, were severely wronged by our profession's lack of forethought regarding post-graduate training, which led to limitations to receive licenses in some states and to practice current podiatry. In 1990, I was one of the lucky few to obtain a surgical program. I was blind to the suffering of my colleagues but did nothing at the time to address the injustice. 

I spent most of my professional career learning and improving my skills and fighting another battle - the battle we still fight, one of parity - to be treated the same, financially and politically, by third-party payers for the same services provided by other specialists; not to be pigeon-holed or separated by the business adage supply and demand, but to be treated the same because of our education and training.

The cancer that plagues or profession includes the disunity between podiatry education and post-graduate training, but more importantly, the inability to find a solution that will lead to parity and consolidation of podiatrists so they don’t have to join “orthopedic groups” (to get paid at the orthopedic surgeons' rates), or to develop a pathway to medicine and surgery, osteopathy, or allopathic medicine.


Ira Baum, DPM, Miami, FL,



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

From: Robert Scott Steinberg, DPM

Your offer proves that there are still gracious doctors out there who would go out of their way to help with this crisis, any way they can. Dr. Roth, I would not take the "run around" you are receiving, personally. I can only imagine the panic these students are living. The "run around" you are experiencing is proof how scared they are. Without a doubt, a year preceptorship could provide invaluable experience, but they are still not moving any closer to getting their license.

I am frightened for these unmatched grads, because I see the huge failure that falls squarely at the feet of the colleges, APMA, and CPME, with their inability to solve the problem, that we all know, is going to grow. In the now seemingly blind quest for parity, these unmatched grads are facing the unintended consequences of Vision 2015.

I can't really blame the residency directors for all of this. They jump though many hoops to keep CPME happy, as it is, and may feel somewhat unappreciated by our leaders. I propose that residency directors be given VERY SPECIAL BADGES for all conferences they attend, so the profession can identify who our true heroes are. Further, though residency directors are the last ones needing additional CME, since their teaching far exceeds all state CME requirements, they should be comped registration fees for state and national conferences. Maybe a show of appreciation will nudge them in the direction of adding one more residency slots, along with CPME's modification of some of the requirements.

Robert Scott Steinberg, DPM, Schaumburg, IL,



RE: Medicare Calling Patients

From: Christopher Orlando, DPM

How can the patient be sure it was Medicare calling? It could be anyone fishing for information. I would never disclose any information over the phone with any caller. If you want information, send me a letter.  I would educate patients not to disclose my personal information in the same way that I protect their personal information.   

Christopher Orlando, DPM, Hartsdale, NY,



RE: Billing Service Fees

From: Cynthia Ferrelli, DPM, Joe DeTrano, CPC

I do not think a medical billing company should be taking a percentage of your gross. If they are not billing for items sold from your office, why would they get a percentage of that money? I have a billing company who charges me 6.5%, but that is only on what they bill/collect. In order to keep more of the money that I earn, my office staff does the billing for the high ticket items like orthotics and surgeries. If your billing company insists on collecting the way they have been from you, I would find another one.

Cynthia Ferrelli, DPM, Buffalo, NY,

There really is no "industry standard" in regard to what a billing service charges a doctor for their work; a firm can charge any percentage or fee they want, and can bill co-pays. It does not mean the doctor has to pay it.

My firm does billing for about 150 DPMs nationally and DOES NOT charge for any upfront payment(co-pays). We can keep track of everything collected including co-pays, but only charge for work we did regarding billing insurance. We then just take our fee out of what we collect via insurance for the practice.

Joe DeTrano, CPC, Medical/Medical Data Resource Providers,



RE: (Andy Dale, DPM)

From: Michael Schneider, DPM

I have been using "Go Payment" from Intuit for two years. There is no monthly fee, and I have been totally satisfied.

Michael Schneider, DPM, Denver, CO,



RE: Replacement for Fabco? (Paul Taylor, DPM)

From: Michael Felicetta, DPM


We have been using MEDI-RIP by a company called Hartman from Moore Medical. It is a one-inch material similar to Coban.

Michael Felicetta, DPM, Toms River, NJ,



RE: Mobile Credit Card Processing (Philbert Kuo, DPM)

From: Kelly Malinoski, DPM

I have used the Square card reader and app on my iPad for patient payments since I opened in January of 2012. I have had absolutely ZERO problems with this form of payment. Patients are impressed with the "new technology" and ease of receiving their receipt via email, via text message, or we can print it out for them. I love it, the staff loves it, and the patients love it.

Kelly Malinoski, DPM, Naples, FL,



RE: Mobile Credit Card Processing (Philbert Kuo, DPM)

From: Jack Ressler, DPM, Michael J. Hodos, DPM

I have been using Square in a satellite office for almost two years and love it. The rates are very low, and you receive payment quickly. There are no monthly charges or minimums. I use it with my i-Phone and the patients seem to like how high-tech it is especially when they use their finger tip to sign their name on the screen of the phone. The option of sending them a receipt via email is also a plus. It allows your patients a fast option for payment instead of having to create a bill and the postage involved for both parties. Square allows for an easy transition to accepting credit cards. No downside! Just contact Square to sign up and order your free card reader.

Jack Ressler, DPM, Tamarac, FL,

My wife uses Square at her private counseling/therapy practice and loves it. We are considering using it in our office. I have no issues with the security of the system, and the cost seems extremely competitive.

Michael J. Hodos, DPM, Wake Forest, NC,



RE: Competency of APMA Leadership (Allen Jacobs, DPM)

From: Lawrence Oloff, DPM

I like to sit on the sidelines. It is a comfortable place to be. However, it is hard to stay silent in the midst of so much misinformation, misplaced loyalties, and lack of common sense. It's time to be refocused.

First things first – the students. The casualties of this fiasco. I respect the good faith efforts of the many people who have taken time to offer their solutions to those students who were unmatched. Many suggested that those unmatched students should spend their lack of residency training in some other way –...

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



RE: APMA Pinterest Page (Brian Kiel, DPM)

From: Crystal Holmes, DPM

As chair of the APMA Communications Committee (formerly the Public Education & Information Committee) that oversees the development of public education campaigns, I feel compelled to respond to Dr. Kiel's comments about the Pinterest page that is part of APMA's spring Beat Bunion Blues campaign. This is a robust campaign that includes video, posters, tip sheets, print articles, media outreach, and more. Social media also plays a role because it is has proven to be very successful in reaching our target audience, women ages 35-55, the health-care decision makers in most American families--and frequent bunion sufferers.

Pinterest is one of the fastest-growing social media sites and is wildly popular among...

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



RE: Dr. Scholl's Marketing Campaign (James Petko, DPM)

From: Stanton C. Southward, DPM

When I was a student in the late '60s, I was worked up about the Dr. Scholl's foot care products displays in drug stores encouraging self-treatment. My surgery professor at OCPM, Raymond Suppan, DPM, advised me to forget about it and remember that Dr. Scholl's has brought public awareness to foot health that actually helps our profession. The OTC custom orthotics are NOT prescription orthotics and do NOT come with a podiatrist guiding the patient's care. Also, be mindful of the fact that the Dr. Scholl's Corporation has literally financially saved the Illinois College of Podiatric Medicine.

Stanton C. Southward, DPM, Colorado Springs, CO,



RE: Optogait (Nicholas Pagano, DPM)

From: Seth J. Steber, DPM


The Optogait video & computerized system by Microgate is an affordable, versatile, portable and very accurate (to a millisecond) gait analysis system. It quickly gives us the quantitative data we need to validate our treatments.  In addition to gait, this one system can evaluate running, jumping, reaction, and balance. Optogait is a very effective system for analyzing patients as a baseline for gait and stability, for rehabilitation progress, and as part of a falls prevention program. 

The wireless system allows you to evaluate barefoot, in shoes, and in shoes with orthoses or braces. We can also evaluate patients who are unilateral or bilateral amputees. Its use in the evaluation of the dynamic motion of the athlete is well-established. The Optojump (Optogait without the capability to add an EMG) system is in all  U.S. Olympic Centers and is used by many professional sports teams in the U.S. and Europe. Optogait is the tool that can elevate our practices for every problem set that we see - your imagination is your limit.


Disclosure: Incedo Orthopedics, LLC is the Certified Podiatric Distributor for Optogait/Optojump, North America

Seth J. Steber, DPM, owner Incedo Orthopedics, LLC



RE: An Inexpensive Chair/Table

From: Michael J. Schneider, DPM

I retired from practice in 2011, but was recently offered a space in Denver. I did not have a chair and everything I saw for sale was just too expensive. I then came across this chair/table sold by The Massage Table Store ( This chair/table can lie flat, and rises and lowers with a hydraulic foot pedal. The chair/table costs $375 and the stool is $45, including shipping. It is perfect for a satellite office.

Disclosure: I have no involvement with this company.

Michael J. Schneider, DPM, Denver, CO



RE: Source for Custom Dress Shoes (Charles Morelli, DPM)

From: Robert S. Schwartz, CPed.


Eneslow makes stylish custom dress shoes for hard-to-fit feet in our on-site lab at 470 Park Avenue South, NYC location. Our custom shoe-makers have over 100 years combined experience. Importantly, we can customize any shoe that your patient already owns to better fit their feet (shoe makeover).

Robert S. Schwartz, CPed, NY, NY,



RE: Changing Office Hours (Olga Luepschen, DPM)

From: Brian Kashan, DPM

I have read multiple posts from both sides of the story regarding changing office hours for Fridays, and still am not convinced by any of them. There are some issues that haven’t been touched on.

For example, in any practice, patient access to care must be addressed. So, there needs to be hours either in the evening, a Saturday, and during the daytime. Do you need all of this? No,

of course not. But if you don’t have this access, mostly for working people, you will lose these patients. I find it somewhat interesting that...

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



RE: Background Checks of Employees (Donald Carlson, DPM)

From: Fay Mushlin

We have been using Backgrounds Online for several years. We are extremely satisfied with their efficiency, quick turn around time, and pricing. Anyone who answers the phone is able to answer your questions and be of assistance. Website:


The company will also supply you with  product and pricing information.


Fay Mushlin, Newtown Square, PA,



RE: Background Checks of Employees (Donald Carlson, DPM)

From: Hal Ornstein, DPM

We have done background checks on employees for years. It is very inexpensive and simple to do. If a prospective employee does not sign the form to allow the background check, the writing is on the wall.  We use International Security Agency, Inc. (, 

In addition, check out This site will help you make better hiring decisions. It indicates the key information you can use to decide who will succeed and who will under-perform – before you make that hiring decision. It reveals if prospective employees' personality traits match those of your practice, as well as your needs and expectations. It is low cost considering the high cost of having to replace an employee. As the saying goes, "pay now or pay later."


Hal Ornstein, DPM, Howell, NJ,



RE: Be Prepared for Healthcare Changes (Joseph Borreggine, DPM)

From: Daniel Grapel, DPM

While I agree with 80% of Dr. Borreggine's extensive post, allow me some remarks. I think that the comparison with dentistry is not proper. While many aspects of our profession can be performed by orthopedists, dermatologists, or physical therapists, dentistry can ONLY be practiced by dentists. Nobody else! In addition, while about 60-70% of all people ever visit a dentist, how many visit a podiatrist? I doubt if more than 10%. This is a huge difference.

Dentistry never had to prove the value to the public since poor dental health can have immediate deleterious effects. With podiatry, it is not so...

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



RE: Kudos for PICA Risk Management Seminar

From: Bret M. Ribotsky, DPM

The SAM meeting this year ended with a great session. The annual PICA lecture that most attend to receive a reduction of our malpractice premiums was the best program they have ever done. Without letting the "cat out of the bag", I encourage everyone at the NY Clinical Conference this week to attend (even if you get your insurance from another source) as it was one of the best 90 minutes I have ever spent at a seminar. Congratulations to Dr. Taubman for his leadership, and to the whole risk management department at PICA. 

Bret M. Ribotsky, DPM, Boca Raton, FL,



RE: The Self Esteem of Podiatry 2013 (Robert Kornfeld, DPM)

From: Gino Scartozzi, DPM

I would like to take an opportunity to respond and further clarify my position in my earlier post for Dr. Kornfeld. In no way would I advocate that any practitioner, or business owner for that matter, routinely be cavalier regarding whether one gets paid or not for services, if he intends to remain in business.

The solution is quite simple, the decision to provide treatment procedures for a patient should not be contingent on where the source of payment will be coming from. It is not the practitioner who is responsible to routinely write-off services that are not covered by insurance carriers. In fact, I feel that it is the responsibility of the practitioner to...

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