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
09/12/2013
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
09/12/2013
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
09/07/2013
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
09/07/2013
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
09/03/2013
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
08/24/2013
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
08/06/2013
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
07/30/2013
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
07/19/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 3B
RE: WI Podiatrist Survives on Patients' Ignorance
From: Name Withheld (CA)
This posting reminded me of a former classmate of mine. What he has done is unquestionably wrong - ethically, and probably morally. Being somewhat intuitive, I began to sense that there was something not quite right about him early on. Some classmates questioned me, but I stood firm. Let's just say that he proved me right - sued by my class, almost expelled by my school, lost his state license a couple of times, and involved in unscrupulous activities.
Which brings me to my question - didn't his school and his residency program see something coming? Did they suspect this person showed some questionable actions? And, if they did, what should they have done and should they have stopped him? COULD they have stopped him? I ask that question about my former classmate, often, wondering if he could have been prevented from causing problems long before they occurred and people suffered? Probably so.
Shouldn't someone have stopped his careen toward dishonesty? Why didn't they help him self-correct before this happened? The buck has to stop somewhere all along the line. Is no one responsible other than the perpetrator? Do doctors always protect doctors? We shouldn't. Wrong is wrong, right?
Name Withheld (CA)
07/16/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: Good Hygiene Prevents Fungal Infections/Odor: Singapore Podiatrist
From: Doug Richie, DPM
To clarify a slight error in the original posting of this story, Chelsea Law is not an Indonesian podiatrist. She practices in Singapore. Through a partnership with the California School of Podiatric Medicine at Samuel Merritt University, I had the privilege of serving as a visiting professor for the entire Singapore podiatry staff in March this year. Ms. Chelsea Law was one of my organizers and hosts for this one-week experience. She is truly one of the most delightful, professional, and compassionate podiatrists I have known. Congratulations Chelsea!
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com
06/20/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2C
RE: Scholl Professor Sues Associate Dean for Defamation
From: Hartley Miltchin, DPM
Healthcare will never be the same in the future due to fiscal restraints. The changes will affect every practitioner in every specialty, but podiatry even more so. The initiatives that Scholl College has made make no sense and only prove that they want censorship and not relevant practice information for the students. Assets of a great school lie in the faculty, not the administration.
The administration is responsible to maintain a top notch faculty. In releasing part-time faculty while they are in the middle of a course only...
Editor's note: Dr. Miltchin's extended-length letter can be read here.
06/15/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2
RE: Unmatched Residency Placement Currently Stands at 92 (Lawrence Kansky, DPM)
From: Philip Larkins, DPM
There has been much chatter about the unfortunate graduates in the last few years who have not matched residencies. This is deplorable for our profession, and should not happen - end of statement. The podiatry schools have now crossed into a place of “for-profit” scorched earth.
These schools do not care one bit about what happens to the graduates of their programs. They are all about the money, and it smells very similar to those ‘other’ for profit schools: Kaplan, Phoenix, etc., just to name a few.
These schools are PREDATORS! They take advantage of humans who really want nothing more than to...
Editor's note: Dr. Larkins' extended-length letter can be read here.
06/14/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2
RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Tip Sullivan, DPM)
From: Larry Kobak, DPM, JD, Don Peacock, DPM
In fact, Dr. Miltchin does teach his techniques along with other podiatrists at LSU Medical School. The AAFAS will be sponsoring its annual cadaver course in conjunction with this fine institution, next week. We cordially invite Dr. Sullivan to participate. It is important that, as a profession, we share our knowledge and experience with each other. I commend both Drs. Miltchin and Dr. Sullivan for their willingness to share over the years. They are both a credit to our profession.
Larry Kobak, DPM, JD, Manhasset, NY, lfkobak@gmail.com
Like Dr. Miltchin, I've had very few complications utilizing minimally invasive surgery for bunions. I have not had a non-union or hallux varus from a bunion deformity that I corrected utilizing minimally invasive surgery. I have been using MIS techniques for bunions for 7 years. It is theoretically possible that he has never had a complication from bunion repair utilizing minimally invasive surgery.
I personally believe that complications do not discriminate on incision size. I have had my share of complications with minimally invasive surgery, including non-union. MIS is just a technique. It's not the only way, and it is not free from complications.
Don Peacock, DPM, Whiteville, NC, peacockdpm@gmail.com
06/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2
RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Randall Brower, DPM)
From: Hartley Miltchin, DPM
Here we go once again "bashing" our colleagues. I learned many years ago that "use what works best in your hands and has the best outcome for your patients."
I have been performing a significant number of minimally invasive bunion procedures, weekly, for the past 31 years. I have never had to repeat a bunion procedure because it has returned. I have never had a patient with a non-union, never had a...
Editor's note: Dr. Miltchin's extended-length letter can be read here.
05/07/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: Laker Basketball Star's Injury May Have Been Preventable: TX Podiatrist (Brian Fullem, DPM)
From: Ed Davis, DPM
How can Dr. Fullem make the remarks about my original communication when he has not read it? The Wall Street Journal story extracted information from my email communication, particularly those items that were of heightened interest due to the recent Achilles rupture by Kobe Bryant. It contains less than 30% of the original content.
There are many theories as to the cause of Achilles rupture but...
Editor's note: Dr. Davis' extended-length letter can be read here.
04/24/2013
RESPONSES / COMMENTS (NEWS STORIES)
RE: 104 Applicants Not Matched for Residency Positions (J. Marshall Devall, DPM)
From: Brian Kiel, DPM
Dr. Marshall Devall recently posted from the perspective of one of the programs and he made an excellent point. Some of these graduates do not qualify for a residency. I am not saying all of them, but a certain percentage just don't have what it takes to be a 3-year resident. Perhaps they, the profession, and the public are better off if some people don't become surgeons.
I searched "options for unmatched medical students" and guess what, there is lots of information about not getting matched after graduating from medical school. There are numerous articles that advise unmatched students in alternatives to a residency including but not limited to getting a secondary degree, taking time to volunteer or work at a job that will strengthen your application for the following year, or even realizing that perhaps medicine was not for you. I do not pretend to think this is a simple problem with simple answers. My point is merely that this situation is not unique, and that perhaps there are some answers that don't involve self-condemnation of the entire profession.
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
04/15/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 3A
RE: 104 Applicants Not Matched for Residency Positions
From: Marc Haspel, DPM, Michael Schneider, DPM
I have been reading with interest and some sadness about the plight of the 104 graduates who were unmatched for residency positions. I agree that this is a tragedy and hope some solution emerges to mitigate the enormous debt incurred and/or a pathway to licensure. While I believe questions should be asked of the ongoing admissions processes at the colleges or even the wisdom of opening new schools, I do not agree with the harsh criticism being leveled at APMA and its collective efforts to elevate the stature of the profession on whole.
For many a time, we as a profession, have sought to move our specialty to one seated at the same table with allopathic medicine. While some of the newer training seems excessive, it is what society demands. Ultimately, familiarity with this professional evolution must be appreciated by all those intent on matriculating into podiatry school. When one matriculates to a podiatry school, one is making a business decision, not an academic one.
Ideally, one should know where one will be heading after all one's education and training is completed. The classic example being the old model of offspring entering a family practice. Being realistically aware of what lies down the road for those thinking of pursuing a career in this field will help to avoid a similar crisis in the future.
Marc Haspel, DPM, Clifton, NJ, mhdpm@aol.com
According to the CPME website, there were 113 new first year residency positions this year. I empathize deeply with the unmatched graduates who qualified but were not afforded the opportunity of a residency. The issue that strikes me is that things have dramatically changed in the practice of medicine since I graduated NYCPM in 1983.
Upon graduation, we had the option of...
Editor's note: Dr. Schneider's extended-length letter can be read here.
04/13/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: MI Podiatrist Sentenced to Prison in Healthcare Fraud Scheme (Ted Cohen, DPM)
From: Lawrence J. Kansky, DPM, JD
Alan Stiebel DPM and Ted Cohen, DPM should be commended for their letters of support of jailed podiatrist, Dr. Anthony Kirk. It is a waste of taxpayer money to jail this man for his alleged misdeeds. Dr. Kirk should have to pay all the improperly received money back with interest, pay a substantial fine, and do much needed community service. May I dare say, his State Board of Podiatry should even let this first time offender practice podiatry under strict billing supervision so he can remain a productive taxpaying member of society.
To those naysaying podiatrists: having defended many alleged criminals in court, there are many reasons innocent defendants take plea deals. Fear of publicity, legal costs, protection of loved ones, not wanting to be subjected to brutal cross examination if they take the witness stand, and facing an unpredictable jury are some of them.
There are many podiatrists getting away with doing far worse things than Dr. Kirk such as performing surgical and office procedures that do more harm than good, prescribing orthotics to everyone who walks in the door, using unnecessary and expensive technology, and denying 104 residencies to qualified podiatric graduates. I wish Dr. Anthony Kirk and his family the very best, and pray for peace in his life.
Lawrence J. Kansky, DPM, JD, Wilkes-Barre, PA, larry.kansky@gmail.com
04/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2A
RE: 104 Applicants Not Matched for Residency Positions (Bryan Markinson, DPM)
From: Allen Jacobs, DPM
WHO or WHAT oversees the number of admissions vs. available residencies? I understand there is no guarantee of the number of graduates, residency survival, and so on. I would simply like an answer to Dr. Markinson's question. Who or what watches the number of admissions vs. the number or residencies?
What, if any, mechanism is responsible to avert this future disaster again? No philosophy please. Just an answer. WHO IS IN CHARGE? Where is our well-remunerated executive director?
Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net
04/12/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2B
RE: 104 Applicants Not Matched for Residency Positions (Vincent Gramuglia, DPM)
From: Bruce Krell, DPM
Well said, Dr. Gramuglia. As I recall, the Scholl College, class of 1987 had a difficult year in obtaining residency programs. Not one person, at any time, ever suggested to me that I would not become a fully functioning podiatrist, participate in a residency, perform surgery, become ABPS certified, and earn a living to provide for my family. I, like my classmates, made my own choices and efforts. Some got and some didn't. Some stayed and some didn't. I for one did what I had to do, and I made it work for me in this profession. I continue to do so today although sometimes it is a struggle.
I find the comments that Mr. Schwartz made are not commensurate with the current trend in the profession given the push towards foot and ankle surgery. However, as stated before, not everyone can be a reconstruction specialist or perform complex surgery. There is a great deal of decent podiatric medicine in an office setting to provide service for, and there should be no need to work at a shoe store to pay for student loans. I would be incredibly upset if I were in the situation that the 104 students find themselves. I hope the leaders who are responsible for this fiasco will step-up and make it right, resign their positions, or their Board of Directors have them fired.
Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net
04/11/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 2B
RE: 104 Applicants Not Matched for Residency Positions (Robert Schwartz, CPed)
From: Vincent Gramuglia, DPM
This is great advice for our podiatry school graduates. I know they all dreamed of the day that they would be opening their own office, joining a hospital staff, preparing for board certification, beginning to make a decent living and raising a family after all their hard work and study at a quality residency program. I never thought of the possibility of working in a shoe store right out of school! As John McEnroe once said, "you cannot be serious." Maybe Rockport, Nike, and Bally should put their names in the match and hold interviews at the CRIP!
Our graduates of podiatry school should not be encouraged to languish in a department store with a shoehorn in one hand and a coupon for 25% off in the other. What's next, the fragrance counter at Sachs? With all do respect to Mr. Schwartz, it would be insulting to these talented individuals, who sacrificed their money and their youth achieving this goal, to suggest that they settle for anything less than what they deserve.
Vincent Gramuglia, DPM, Bronx, NY, a2onpar3@optonline.net
04/06/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions
From: Bret Ribotsky, DPM
To the 100+ graduates of podiatry school without a clear path today, I want to share a lesson in life, “Sometimes your worst times become your best.” I have had the opportunity to interview over 210 (so far) of the best podiatrists in the country on Meet the Masters and there are a few distinctions that are evident. Regardless of any bad situation (divorce, death of a family member, hurricane, or fire), what you focus on that will affect your destiny and, in turn, your life.
Dealing with the problem in front of you today, I offer a few suggestions for you to consider:
• Contact residency programs and offer to attend without compensation. Even if you do not get credit, you will gain...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
03/30/2013
RESPONSES / COMMENTS (NEWS STORIES) - PART 1B
RE: 104 Applicants Not Matched for Residency Positions (Jeanne Arnold, DPM)
From: Philip Radovic, DPM, Joseph D. Pasquino, DPM
The residency shortfall crisis requires immediate attention. An instant impact might be made in generating more entry-level positions by having CPME rescind the requirement that a hospital be a sponsor/co-sponsor for residency approval. This would bypass much of the burdensome red tape required by hospitals for sponsorship. The vast majority of podiatric surgery is performed in outpatient surgery centers across the country. Many surgery centers have the resources to financially support a residency and can affiliate with a hospital for inpatient training and trauma rotations, etc. (the hospitals can still obtain GME dollars).
Shifting first year residents to these entry level positions for a two-year certificate would allow for state licensure in most states. Those seeking further training could obtain it through the limited 3-year programs or fellowships. I have asked CPME to consider this avenue.
Philip Radovic, DPM, San Clemente, CA, phil@feetfixer.com
In an answer to certain of the concerns about the residency shortage raised in the letter from Dr. Arnold, I direct PM News readers to Resolution 13-13 presented to the March 2013 APMA House of Delegates by the Pennsylvania Podiatric Medical Association and seconded by the New Jersey State Podiatric Medical Association. This Resolution is on the APMA website and it contains the most up-to-date facts concerning residency development that we could determine.
If the current programs in development are authorized, we are told that will...
Editor's note: Dr. Pasquino's extended-length letter can be read here.
