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03/27/2014    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Arnold Ross, DPM, Burton J. Katzen, DPM


 



I enjoyed the three-year program. Unfortunately, the plan to have more grads was questionably calculated. In California, the old CCPM had approximately 100 students per class with a podiatric hospital and fully functioning orthotic lab. Now, we have two schools in California with approximately 100 students or less in total, and no hospital or orthotic lab in either.


 


Arnold Ross, DPM, Los Angeles, CA, asross1@juno.com



 


I cannot believe that anyone in our profession could possibly vote for the 3-year podiatry curriculum. Before I looked at the results, I thought the voting would be less than 1%. First of all, as one of my colleagues stated, there is way too much to learn for even four years. Also, for those of us who have been around for over 40 years, if you think we were looked down upon by our medical colleagues and the general public in the past, this would be a public relations disaster, not to mention a credentialing disaster for hospitals, etc.


 


One viable alternative would be a 6-year college/podiatry degree program like Hopkins and several medical schools have, or at least I know had in the past. This would especially be a viable alternative for schools affiliated with undergraduate schools like Temple. Also, we're the only profession that is trying to force every graduate into becoming a surgeon with a 3-year residency to even get a license in most states. This is extremely detrimental and costly to the students wishing to provide for patients needing other types of care, and for our profession in general.


 


Burton J. Katzen, DPM, Temple Hills, MD. DrburtonK@aol.com

Other messages in this thread:


05/07/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Robert Scott Steinberg, DPM.


 


Lawyers do not bill Medicare for billions of dollars. Lawyers aren't the ones ripping off Medicare. And Florida is the epicenter for Medicare fraud. Don't take it so personally.


 


Robert Scott Steinberg, DPM. Schaumburg, IL

04/21/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: John S. Steinberg, DPM


 


We apologize for what your friend experienced. However, it is unfair to turn this misinformation into an accusation that Georgetown is somehow discriminatory towards podiatric surgery. I am the co-director of the Center for Wound Healing at MedStar Georgetown University Hospital. Our team is composed of podiatric surgeons, plastic surgeons, vascular surgeons, nurse practitioners, and numerous other specialists.


 


MedStar Health is a system of over 36,000 employees with 10 hospitals, so I cannot speak for every circumstance, but I can tell you that podiatric surgery is well established here and is not in a discriminatory status. I believe it would be best for you and me to speak directly about what happened rather than have this debate on PM News. Please contact me at 202.444.3059 and I would be happy to reach out to your friend to provide assistance.


 


John S. Steinberg, DPM, Washington, DC

04/19/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: An Open Letter from Greg Sands of Ortho-Rite to His Customers


From: Greg Sands


 


Within a few short months, and after a catastrophic fire that completely blindsided me, Ortho-Rite is up and running. It’s good to be back! I am not sure how the fire started. What we do know is that the paper storage is where it started. Paper storage is a ticking time bomb. How it started will remain an unsolved mystery. 


 


The first thing I want to do is thank my customers for their loyalty and support. I know that the fire has disrupted practices and hurt patients nationwide. I was overwhelmed and shocked, but I focused all my energy to rise above the ashes and rebuild. The building bureaucracies of this new town kept us from operating sooner. To circumvent the red tape, we worked a night shift to get things going. We have cleared the hurdles and we are now producing. Three months of anguish and stress have finally come to an end. I will do anything I can to make whole anybody who was adversely affected.


 


It was tough getting restarted after going for so many years. For the rest of my time in this industry, Ortho-Rite will be committed to make it up to all of you who were compromised. I am truly sorry for what happened. I want to maintain and exceed the level of product and service that you were used to. My entire team remains intact and eager to take care of everybody as usual. 


 


Greg Sands, Owner of Ortho-Rite

04/17/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Simon Young, DPM


 


I agree with Dr. Jacobs. The one word he used that must be analyzed is “normal”. Insurance companies rate you in relation to your peers. If let’s say, 90% only do C & C, then anyone who does more and deviates from the norm and bills for it falls out of “NORMAL”. The more standard deviations away from normal, the more ABNORMAL your practice is and they don’t question and evaluate why a practitioner is more observant and caring, but instead can consider it fraudulent. 


 


We as a profession “old” or “new” must change NORMAL. No one will admonish you for raising  a patient's pants legs and looking for abnormalities for referrals, if needed. This will save lives and hopefully garner respect. It’s sad we don’t look at legs routinely, no matter what the state laws. It’s preposterous to think we only did it for whirlpool treatments!


 


Simon Young, DPM, NY, NY

04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Kudos to Amerx Healthcare


From: Ted Mihok, DPM


 


I would like to thank the Amerx Healthcare Corporation for contributing wound care products to our Lions and Rotarian's Joint Service Project in Mexicali, Mexico on April 4 and 5. They have been a partner for over ten years and their generosity is greatly appreciated. The service project has been going on for over 42 years and consists of both medical care and construction in and around Mexicali, MX.  


 


Ted Mihok, DPM, Alameda, CA

04/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Jeffrey Kass, DPM


 


I am not sure if all the negative comments about Costco orthotics are well guided. I, like most of my colleagues, watch shark tank - and I say kudos to the people who came up with the idea. It's rather ingenious, and from a business point of view, I think they will make money. I think it's ludicrous to point to the inferiority of the product without having seen it or tried it. That is sheer jealousy. Some of my colleagues have been known to have their secretaries cast patients, yet no one is up in arms over that. I'm not sure that I can even agree who the experts are or if there are any when, as Dr. Shavelson points out, there are no studies proving anything. 


 


The more important question is - should the profession have been able to deem orthotics prescription products to be prescribed only by doctors, and did the profession let us down in that regard? What exactly is the Costco process? When the operator is quizzing the patron on what ails, can this be construed as a medical exam that the operator should not be doing? 


 


Jeffrey Kass, DPM, Forest Hills, NY

04/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Brian Kiel, DPM


 


I, just like many podiatrists, see patients who have been treated by Costco and urgent care facilities. I, like Dr. Jacobs, will not deal with devices that others have made. I explain that it is a useless device and I cannot and will not take responsibility for them. On the other hand, if someone comes into my office with a boot and a fracture, or an improperly treated condition of the foot, I don't feel that we can or should refuse them. If another facility screwed it up in the first place, then they probably won't get it any better the second. It is our responsibility to do everything we can to help that patient. Of course, proper charting regarding the prior care is critical, but we have an ethical responsibility to care for those patients.


 


Brian Kiel, DPM, Memphis, TN

04/05/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: David S. Wolf, DPM


 


I respectfully disagree with Dr. Udell's post, "How would you feel if that person leaves your practice and gets a job working for an MD across the street and the doctor starts advertising that he or she now provides foot care by a well-trained PA or NP." These "podiatric insecurities" are still unfortunately part of the paranoia that was ingrained into our training and psyche. When podiatrists whom I have trained moved down the street, it never negatively affected my patient load; it only increased my bottom line. 


 


Competition is good and healthy as it raises awareness of what a podiatrist's scope of practice is. With the obesity crisis in this country, there will be more work for all of us (think wound care,diabeties, plantar fasciitis, etc.). 


 


Having NP/PAs you have trained who work in a PCP's office will only enhance your practice as they will know what services that they and their new boss do not want or know how to do. "The more the merrier".


 


David S. Wolf, DPM, Houston, TX

04/04/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Tina R. Sechrist


 


Our office has been working on this issue as a mass adjustment project with Palmetto GBA since early March.  The following has been posted on the claims issue log of Palmetto:


 


Issue Identified 3/26/2018: It has been determined that a routine foot care service edit, based on the Routine Foot Care Local Coverage Determination (LCD), L37643, has been edited incorrectly and only allowing one CPT/HPCPS code identified in the LCD per patient, per claim. This issue affects claims for dates of service on or after February 26, 2018.


 


The editing will be updated to reflect the LCD’s intent, which is to allow any medically necessary routine foot care services for a given patient once within a 60-day period. Providers must bill all routine foot care services for a 60-day period together on one claim for one date of service. The CMS Mutually Exclusive Edits to prevent improper payment when incorrect code combinations are reported will continue to apply to each date of service billed.


 


Provider Action: 3/30/2018: There is no provider action. This CPIL will be updated once the editing has been updated and Palmetto GBA will perform adjustments on affected claims. 


 


Tina R. Sechrist, East Cobb Foot & Ankle Care, Marietta, GA

03/22/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Paul Kesselman, DPM, Simon Young, DPM


 


Thanks to Dr. Borreggine for pointing out it was a PA at the derm practice who wrote the Rx. He is absolutely correct that all prescribers should have some sense of the patient’s cost of their prescription regimens.


 


Paul Kesselman, DPM, Woodside, NY


 


I am incensed at the term “fake news”. It is a term to indicate intent on lying vs. ignorance. Furthermore, it’s a term used by leaders who are authoritarians and themselves are promoting false ideology and facts. Yes, Kerydin and Jublia are not compound pharmacy drugs, but they surely charge the same. The PA might have been misinformed or didn’t care. It's true that the patient did have documented onychomycosis, but was her health in grave risk? These abuses nevertheless should be exposed. 


 


We should ask the Reps what are the costs of these medications. Anything products advertised or promoted by a Rep. are really, really expensive. It’s unconscionable to pay $1,500 for 10 ml Kerydin or 8 ml Jublia. Treatment can cost over $10,000 for let’s say 10 nails with a low cure rate, provided it’s involving the matrix. Anterior superficial, you can bump up  the cure rate to 26%. 


 


Boutique pharmacies charge outrageous prices but we write the prescriptions and they laugh all the way to the bank, and insurances and patients blame and complain to the prescribers. If you have commercial insurance (NOT MEDICARE, MEDICAID, TRICARE), you can pay out- of-pocket for $100 in my office area. What’s wrong with that picture? This is an outrage which doesn’t only involve podiatric practitioners but all medicine and should be outlawed and regulated. This has little to do with R&D. R&D is a farce at this point.  


 


Simon Young, DPM, NY, NY

03/14/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Sara Tradup


 


We have our old x-ray films recycled and they will pay you for the silver content and provide you with a certificate of destruction. We use B/W Recycling – they will even cover the shipping costs to send x-rays to them as long as you have at least 50 lbs of films. We have used them three times so far over the years, with great service every time


 


Sara Tradup on behalf of Peyman Elison, DPM, Surprise, AZ

03/08/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Lack of Podiatric Authors in Our Journals 


From: Bryan C. Markinson, DPM


 


Many have lamented and seek answers on the lack of high quality peer-reviewed published podiatric research. Some blame the colleges, others blame APMA. I take a different view. Why does there have to be blame on any level? The importance of original academic research in medicine is self- evident. However, it is still a minority in all fields who churn out the research. 


 


Be that as it may, since 1977, when I started podiatry school, there was NEVER a milieu for research in any of our colleges. Original research is much more complicated than one might think, and very costly. Since working in a very research-oriented academic institution, I can tell you that “research” is done on weekends and nights, with armies of...


 


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

03/07/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Kathleen Neuhoff, DPM


 


I am a veterinarian as well as a podiatrist. As a requirement for achieving board certification, it was necessary to submit two papers suitable for inclusion in a peer reviewed journal in addition to the usual case presentations and two days of testing. One of the reasons this was done many years ago was because the feeling in veterinary medicine is that one of the main differentiating factors between a profession and a trade is the production and publishing of research. If such a requirement became a part of the board certification requirements for podiatry, I am sure we would see a rapid expansion of research!


 


Kathleen Neuhoff, DPM, South Bend, IN

02/28/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Name Withheld


 


Kudos to Ms. McCormick for bringing this issue to light regarding continued use of chemicals to "disinfect" podiatry instruments. From what I recall, most of those chemicals only sterilize an instrument after 6-8 hours or more of being immersed. Since most podiatry offices are turning over a patient every 15-30 minutes, there is serious potential for spread of onychomycosis, MRSA, Hep C, etc. from patient to patient if these chemicals are utilized. 


 


There will be others that disagree, but there is no excuse to not have an autoclave and sterilize every instrument between patient use! Autoclaves are not that expensive and we have advanced beyond chiropody. Those that are still using chemicals are no better than some of the pedicure salons that...


 


Editor's note: Name Withheld's extended-length letter can be read here.

02/26/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Janet McCormick, MS


 


The EPA-approved label on Benz-All says weekly. It does not say, however, if Benz-All is rendered ineffective by bioburden, meaning it might or probably needs to be changed earlier. The EPA requires that hospital disinfectants kill certain benchmark microbes and Benz-All does that. Many disinfectants, however, are tested for further levels of kill, and these are added to the label as "label dressing" since no disinfectant at this level kills everything. In other words, it's designed to improve sales. Keep in mind that there are many organisms it does not kill, but that is true of every disinfectant, no matter the brand. Only sterilization kills them all = use of an autoclave.


 


There are those that say disinfection is the okay-level of care for podiatry instruments unless you are performing invasive treatments. But any treatment can cause any level of invasion by instruments (in any type of care - podiatry or otherwise), even by accident, so any procedure must be performed under aseptic conditions Doesn't that call for sterilization of instruments in podiatry? Even in the offices? I am always shocked when I go into a podiatry office and there is no autoclave! But it happens way too often! In a survey of podiatry offices in my area, 4 out of 6 offices did not have an autoclave. 


 


Janet McCormick, MS, Frostproof, FL

02/26/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Richard J. Manolian, DPM


 



I for one would not want to be the doctor who gets inspected and has to then prove how much of this product I bought to match the patient load and requirements of changing it on a 2 to 4 week basis depending on whom you listen to.


 


In addition, I would then have to show proper paperwork as to the change in schedule and process of how instruments were utilized in the setting. Gas or steam sterilization seems to me a more definite way to avoid this quagmire with any board of any state.


 


Richard J. Manolian, DPM, Cambridge, MA


02/01/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Name Withheld 


 


A few years ago, a well-respected practitioner passed away in an untimely manner. He had a long standing practice that was busy from day until night, a modern office in a building affiliated with a top hospital and well-trained staff. His practice continued in the interim with help from volunteers, but when his family tried to sell it, they could not get a reasonable offer for the practice; not even an unreasonable one.


 


Instead, someone who purported to be “a friend” opened up a new office in the same building and poached the patients with a blitz of advertising. Setting up the new office and the professional marketing campaign cost maybe 20% of what he would have paid the family. Within a couple of months, he enjoyed the same busy practice, in a modern office, affiliated with a top hospital and with a well-trained staff. And he had paid pennies on the dollar.


 


I came to believe at that moment, after decades in this business, that a practice has no inherent value. It is no longer the “retirement account” waiting for us. If I had it to do over, I wouldn’t consider buying a practice. I would open one near an older practice and with marketing’s help become the newest, best-trained, most modern option available. Face it. Patients love the next new thing. Only our older patients look for long-term relationships, and they aren’t going to help sustain a practice. Patients these days look on Yelp for ratings to make their healthcare choices!


 


Name Withheld

02/01/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Robert Fridrich, DPM


 


In late 1970s, I gave those flu shots due to an epidemic in Cleveland.


 


Robert Fridrich, DPM Retired, Green Valley, AZ

01/31/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: PC vs. LLC vs. PLLC (Marianna Blokh, DPM)


From: Joseph Borreggine, DPM


 


I suggest you review these articles that I found through a simple Internet search: Article 1, article 2. And after reading them, then I would decide. But before you do so, know that President Trump’s new tax (law) makes an LLC more attractive than a PC by helping to reduce your pass through income in an LLC by 20%. The corporate tax rate has also dropped from 35 to 21%. 


 


This article helps explain the new tax rules for 2018 for pass through income: But, when all is said and done, a good CPA and tax attorney must be consulted to secure the best advice.


 


Joseph Borreggine, DPM, Charleston, IL

01/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: William D. Spielfogel, DPM, Vito J. Rizzo, DPM


 



This is an excellent initiative by NYSPMA and it is great that the Board of Trustees is being proactive in its advocacy for podiatry. They are an example of an organization advocating for its membership and trying to get a seat at the table.


 


William D. Spielfogel, DPM, NY, NY 



 


In our rapidly changing healthcare delivery paradigm, it is imperative that there be opportunities to help define what a particular category of healthcare provider can offer to contribute to the problems facing our population. Policymakers need to be educated on the facts as they relate to outcome statistics and verified cost factors. Many of these policy considerations are determined in a federal or centralized system. Podiatry’s first advocate should be the APMA. As experience has demonstrated, podiatry seems to be not permitted “a seat at the table”, and this profession is often caught needing to try to fix policy shortcomings after the fact. This has proven to be bad policy. 


 


I applaud the effort of the NYSPMA, which has been the leading advocate for progressive healthcare policy specifically as it relates to podiatry and to the communities we serve. NYSPMA led the charge, resulting in the Thompson Reuters Study which demonstrated the value of podiatry in the care of lower extremity manifestation of diabetes. NYSPMA has been trying for years to have care measurements developed specifically for podiatry, which could then force payers to better consider podiatry as a key partner in many healthcare scenarios. This effort in population health is the next phase of what has been a multi-year and ongoing effort to demonstrate the need for podiatry’s inclusion in a myriad of ongoing and pressing healthcare issues. The opioid crisis, fall risk, and the ever present concern with the ever rising costs of managing the effects of diabetes are areas where it has once again been shown that with podiatry on the team better outcomes and lower costs result. 


 


I encourage APMA, and all of its individual components, to carefully consider and then support the work of NYSPMA as a national effort. In the big picture, it will help podiatrists and their patients throughout the nation, and not just in New York.


 


Vito J. Rizzo, DPM, Bay Shore, NY

01/10/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Historical Perspective on Podiatry


From: Bruce Lebowitz, DPM


 


Since retiring, I have become a docent at a Johns Hopkins museum. As such, I have learned a great deal of history. When I entered classes at MJ Lewi Podiatry school, I learned that in 1912 organized medicine had ignored the foot. Dr. Lewi helped create the school in order to fill the gap. I’ve now learned more about the state of medical care in the late 19th and early 20th centuries.


 


Johns Hopkins University and medical school were founded at the end of the 19th century as a result of Mr. Hopkins' will which allotted some 71/2 million dollars toward that end. Nevertheless, the U.S. economy took a fall at the same time, making it impossible to get the school off the ground. As it turned out, the Hopkins board found a donor willing to shell out the extra millions. Mrs. Garrett, a wealthy philanthropist, donated the funds with a couple of strings attached. One, women would have to be admitted every year. Second, there would have to be students accepted who had achieved academically in college.


 


She did this because she well knew the state of medical care in this country was awful. She knew too that there were American medical schools graduating doctors who could not read or write. So, podiatry began out of need around the same time as academic medicine did. How’s that for parity? 


 


Bruce Lebowitz, DPM, Baltimore, MD

01/08/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Brian Kiel, DPM


 


First of all, if one is to publicly praise and justify the actions of Joseph McCarthy, why are you ashamed to let us know who you are. He was publicly disgraced and proven to be a liar and was the precursor to the same political hate game we are seeing today. This "withheld" person is looking for ghosts under every bed and is obviously a proponent of the extreme right wing political persuasion. I disagree with his basic premise, but he has every right to espouse it, just don't do it behind a curtain. What are you ashamed of if not your views?


 


Brian Kiel, DPM, Memphis, TN

01/08/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Mike Kempski


 


I work on the insurance side of medical malpractice and have twenty five years of experience. In the early years of the Data Bank, the doctors had great concerns about entries against them. The concern was so intense that the carriers responded by changing their policy language as it relates to the settlement of claims. The change was the policies stated they won’t settle a claim without your consent to do so. However, I don’t think there was much reason to be worried. There’s very limited access to the Data Bank. For example, the general public (your patients) can’t access it. Medical malpractice insurance carriers can’t. Hospitals can. But they’re always very reluctant to revoke privileges. How has it hurt physicians?


 


Mike Kempski, Plymouth Meeting, PA

01/03/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Regulation for Power over Physicians and Surgeons


From: Michael M. Rosenblatt, DPM,


 


The abuse of physicians is clearly a byproduct of progressive liberal rule of the United States. Ostensibly, it is "couched" in regulation to raise the standard of care and "limit" damage by "incompetent or dangerous physicians." The regulations and their promulgators always say this is for the public good. It has nothing to do with the public good or protection. It is entirely regulation for POWER over doctors and professionals. It creates "boards of review" who are not qualified in most cases and also exposes physicians to "Star Chamber" procedures and accusations with absolutely no civil rights. 


 


Make no mistake: Regulation is for power. It has no intent or purpose otherwise. It also creates boards and employment for non-professional people and expands government into every aspect of our personal and professional lives. Physicians must be careful for whom they vote. Bigger government means lack of rights without improvement in opportunities. Marxism is a byproduct of big government. This country has been on a rolling slope toward cultural and professional Marxism with Democrats in control. 


 


The "members" of these various committees are fools if they believe they are on the "right side." It is only a short step, under accusation of another person who wishes to take away your rights, your profession, and your money....to be ON the other side and become a target yourself. 


 


Michael M. Rosenblatt, DPM, Henderson, NV  

01/02/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Best Way to Study for 10-Year Forefoot Boards


From: Mark L Miller, DPM


 


I just recertified last year for the second (and last) time—the Goldfarb Board Review Course was all I needed. I took the class over a weekend and then took the test the next week. Everything was fresh in my head and the test was not bad at all. As one of the instructors in the course said, "the recertification test is testing what you do every day."


 


Mark L Miller, DPM, McLean, VA
Mycoside3