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11/09/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Tip Sullivan, DPM
The day that the state board of medical licensure in my state refuses to issue a license to practice podiatry to someone on the basis of the physician's choice to participate or not participate in a federally mandated health program will be a sad day for me.
Such an action would make me consider a change in vocation as well as location. One question that I have thought about: since we are not “physicians” and “physicians” are prevented from forming labor unions has anyone considered forming a podiatry labor union? Has APMA ever considered this to consolidate ALL of us—is there a legal opinion on this?
Editor's Comment: Podiatrists are presently part of the Office and Professional Employees International Union (OPEIU) Guild 45/The First National Guild for Healthcare Providers of the Lower Extremity.
Other messages in this thread:
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Alan Bass, DPM
This is very troublesome to hear. This is why it is so important to review your collections report, as well as your accounts receivables monthly with your billing company. At this time, I suggest the following steps be taken:
1. Contact your malpractice carrier and alert them to this and ask if your policy with them contains administrative defense coverage (ADC) and if it will cover any audits that may arise from this. Hearing that this was for skin substitute claims leads me to believe that these were for Medicare recipients and that can be very problematic.
2. Contact the billing company and alert them to their inappropriate billing practices. You should ask them to return any monies to you that they were paid on the inappropriate claims, since the monies reimbursed by the insurance carrier should be refunded to them.
3. Contact the insurance companies for these claims and inform them that you are aware that you were reimbursed inappropriately for certain claims and discuss reimbursing them for the inaccurate claims.
4. Contact your accountant regarding any tax implications this may have.
5. Consider switching your billing company. I would review the last several months of billing to see if this happened previously.
Disclosure: I am the owner of my own podiatric-specific billing company.
Alan Bass, DPM, JARALL Medical Management Consulting
03/02/2016
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: George Jacobson, DPM
There may be general and or specific requirements by your state or state board. For example, you may be required to publish legal notice of the closure with specific information required by your state. Ask a healthcare attorney in your state. When my oncological surgeon passed away a decade ago, I wanted to secure my records. There was a legal notice in the newspaper instructing patients. His estate had a third-party administrator maintain the records for a said period of time. I paid a fee for the records.
George Jacobson, DPM, Hollywood, FL
09/26/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: J.C. (Chris) Mahaffey, MS
If the Wyoming podiatrist referred to is an ACFAS member, please have him/her contact me regarding the College’s Credentialing and Privileging Advisors Team. We have a team of members, all of whom have served on a hospital credentialing committee, who can advise you on this matter. The College has other resources I would be happy to discuss with him/her.
J.C. (Chris) Mahaffey, MS, Executive Director, ACFAS
09/25/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: John Chisholm, DPM
This is the type of problem that can be dealt with quickly and effectively by your local APMA/state local component association. Most state associations, in my case the California Podiatric Medical Association, have the knowledge, experience, and, if necessary, legal resources to correct any discriminatory position of your local hospital.
It is also a good example of why every podiatrist, in practice or retired, should belong to APMA and their state component association. In order to do this kind of work for its members, APMA needs everyone to pull their fair share of the load, and this includes the financial support of its dues-paying members. If you are an APMA member, contact your state component association and they will get this matter straightened out quickly. If you are not a member, then join today.
John Chisholm DPM, Chula Vista, CA
12/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Elliot Udell, DPM
Many physicians are faced with this same problem. They do not admit too many patients to their local hospitals yet need to verify that they are on staff of a hospital for the purposes of insurance credentialing. What our local hospital system has done was to create an on-staff privilege, which does not allow the doctor to admit patients but allows him or her to read charts and visit but not treat patients. It is a win - win situation for the physician and the hospital. On one hand, the doctor no longer feels impelled to admit more patients than is necessary and on the other hand the hospital still makes their share of dues from each practitioner.
Elliot Udell, DPM, Hicksville, NY
12/18/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Donald R Blum, DPM, JD
"....When I received the new patient paperwork, an arbitration document was included in the packet for me to sign. It basically stated that if I felt dissatisfied in the care I received and I was considering a medical liability claim, I could arbitrate the matter with the institution where the care was provided instead of a seeking legal counsel."
I think the key word in the notice is "could". To me, this is giving you the option to arbitrate versus making it the only option. Please do not construe this to be legal advice. I also suggest asking them the meaning of the notice.
Donald R Blum, DPM, JD, Dallas, TX
07/12/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Michael L Brody, DPM
The disclosure of patient information for professional purposes such as board certification is an allowed disclosure under the HIPAA regulations.
1) You are bound by the minimum necessary rule and can only disclose the minimum amount of information necessary to accomplish the task at hand.
2) Patients have a right to an accounting of disclosures, so you will need to log the disclosure and provide the log to the patient upon request.
As long as you are only disclosing the minimum amount of information and are logging each disclosure, you are compliant with the HIPAA regulations. For more information, you can download the HIPAA Omnibus Rule from the Federal Register.
06/26/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Richard W. Boone, Sr.
This inquiry actually raises two issues: 1. Can the physician own the pharmacy? and 2. Can a physician sell drugs to his or her patients from a pharmacy that he or she owns?
The answers to both questions will depend upon the law of the state in which the physician practices. In my home state, Virginia, the second question is easiest to answer: A physician may not sell drugs to his or her patients unless he or she is also a licensed pharmacist. [Code of Virginia § 54.1-2914.] I suspect the answer will be the same in the majority of states but, as noted, each state has its own rules and you have to determine what your state's rules permit or prohibit.
The first question can be a little more difficult to answer. I suspect that Virginia would permit a physician to own a minority interest in a pharmacy, provided that the pharmacy doesn't sell drugs to the doctor's own patients. (In other words, there can't be any connection or business relationship between the doctor's practice and the pharmacy.) However, any business connection between the clinical practice and the pharmacy which tends to direct the doctor's patients to the owned pharmacy is probably impermissible. But, once again, it all depends on your state's law.
04/16/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Raymond F Posa, MBA
This doctor's story is disturbing, and while we don’t want to distrust our employees, in the medical field with the sensitive nature of the data we have, we need to have protocols in place to prevent such occurrences. They should be articulated in your HIPAA security manual.
When an employee is going to leave your practice, the protocol should be to pay them two weeks’ severance and immediately lock down all of their user accounts as soon as they give notice. I have experienced another situation where the employee leaving the practice took lists of all of the practice's patients so as to use them at another practice. That final two weeks tend to be very unproductive weeks on behalf of the outgoing employee, and leaves the practice vulnerable to all sorts of mischief and possible damage.
On a second point, the doctor mentioned that the employee deleted all of the mail from the Gmail. For the record, Gmail and Yahoo and any other free email accounts are NEVER to be used for the communication of ePHI. Only domain email accounts which are encrypted may be used. Also, had this doctor used domain e-mail, even if the employee had deleted the mail and emptied the trash folder, you would still be able to go onto the e-mail server and get your e-mails.
12/05/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Philip J. Shapiro, DPM
Your malpractice carrier can give you overall guidance as to what you should have, but the general concept is ABC: Airway, Breathing, and Cardiac. Prior to an emergency response team arriving at your office from a 911 call, you should be able to respond quickly and efficiently to anaphylaxis, seizures, cardiac arrest (crash cart plus your documented proficiency in ALS), diabetic reactions, hyper- and hypotensive crises, and other medical emergencies that can, and periodically do, arise in podiatric clinical settings. Equally as important, your entire staff should know what their role is during an emergency.
When purchasing a crash cart, be certain that you have a system to check on the expiration dates of the medications as well as periodic monitoring of the oxygen tank level. Emergency equipment should be easily accessible, and all staff members should know where it is and bring it to you – never leave a patient unattended in an emergency. Possession of a crash cart alone is insufficient; the training and the system that you have in place to use that crash cart effectively is what makes the difference.
12/03/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Ira Baum, DPM
With respect for Dr. Vito, if you drill down his clear, yet complex combination of solutions, I think the issue becomes transparent. The problem is the convoluted certification classification system of the ABPS. The classification system appears to have its origin from podiatrists confronting obstacles to perform surgeries that they were trained to perform, in bona fide podiatric surgical residency programs.
The podiatrists were unfairly scrutinized primarily by orthopedic surgeons and subsequently...
Editor's note: Dr. Baum's extended-length letter can be read here.
11/23/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Eric M. Hart, DPM
I have been in practice for a little over four years. I practice in a different region of the country, but my answer would be the same if I were practicing in California where I attended school or in Utah where I completed my residency training. Without a doubt, we should all be making referrals for problems outside of our scope of practice. That's why people make referrals to us. They are sending care to us that is outside of their general practice in most cases.
Making referrals has led to better relationships with my physician peers, and most importantly to better overall healthcare for my patients. We treat "people with feet and ankles" not "feet and ankles with people" so I feel a responsibility to refer, document, and follow through with any health complaint that my patient may have. When I make a referral, I remind the patient that it is their responsibility to check with their insurance provider regarding any requirement that the referral come from their assigned primary care provider and to determine who is within their network.
11/20/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Richard Rettig, DPM
Jim Scales, DPM may certainly be correct that in his state, the BC/BS plan will put the word 'pathway' on the ID cards of those buying exchange ACA insurance. I am not clear how that is important. I agree that it is very important that some doctors will not be selected as providers for these plans. I suspect that BC/BS did not choose randomly, but established participation based on the hospital-based affiliations of those doctors.
I think that this could be derived by two separate items that Dr. Scales mentions: 1. not one podiatrist in his area is on the plan. 2. the two hospitals that his daughter uses - I presume they are the hospitals in the area - are not on the plan. Insurance companies have always established networks of participating hospitals and affiliated doctors based on contracts they negotiate with the hospitals, including employer-sponsored plans, and they will be doing this more and more, regardless of ACA. That is called the free market, a tenet of conservatism. I am not clear if the protesting doctors are against "Obamacare" or upset because they are not allowed to participate!
11/11/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Robert Scott Steinberg, DPM, David Gurvis, DPM
Dr. Rettig, Thank you for pointing out the obvious. Most of us get it, but it had to be said! I suggest to those of you who are against the PPACA (and no, I do not care to know why), that if you want to close your practice to those you "suspect" of being on "Obamacare", you are doing your more enlightened colleagues a huge favor. You may want to think twice about it, though, as you may accused of discrimination.
I have to agree with Dr. Rettig. There is no Obamacare insurance. I certainly do not expect to have a patient walk in with a plastic card with Obama's grinning face on it demanding care.
Actually, I have just received notice from Anthem that says pursuant to my contract, I am now enrolled as a provider in Anthem X - X for exchange. The so-called Obamacare. I imagine I will get something similar from Cigna, ...
Editor's note: Dr. Gurvis' extended-length note can be read here.
09/24/2012
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
RE: Stark Violation? (Joseph G. Smith, DPM)
From: Steven D Epstein, DPM
It amazes me that so many podiatrists still have such a low opinion of themselves. I should say right off that I've been just as guilty, grabbing whatever deal I could get when I needed the money. But there comes a time when we have to think for ourselves - not, will my competition grab the spot, but is this actually good for me?
This has nothing to do with "banding together." It has everything to do with whether you are proud of yourself, your work, what you do, and who you are. Under the best of circumstances, nursing home podiatry sucks. Treating patients seated in wheelchairs, moaning in pain when...
Editor's note: Dr. Epstein's extended-length letter can be read here.
Steven D. Epstein, DPM, Lebanon, PA, sdepstein@yahoo.com
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