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03/27/2014    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


Dr. Musser asked for advantages and disadvantages. I'll give you one big disadvantage. If you do not do plaster slipper casts, then there is really nothing that separates you from chiropractors, physical therapists, pedorthists, or the shoe store salesman who does a scan. It does not matter which scanner you use. They all make you run-of-the-mill and..... beige. Let the slings and arrows fly, especially from those of you who don't want to get your hands dirty, or those of you who have "trained" your office staff to handle the mundane stuff, or those of you who failed to master the art of casting.


 


Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

Other messages in this thread:


07/27/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Time Wasted


From: Larry Schuster, DPM


 


An insurance company just requested we fill out and attest to demographic information on our practice. We have done this many times for many insurance companies. We usually look at a page of pre-filled info, and if no changes, click approve. It takes 5 minutes maximum. If you need passwords, etc. to get on the site, it takes a little longer. .


 


We are seeing more complex forms every day to the point of craziness. Today, I received a request to fill out such a form with the recommendation that I attend a 30-minute webinar on how to fill out the form. I will have to do this after finding my sign-on credentials.


 


Larry Schuster, DPM, Parsippany, NJ 

07/19/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Arnold B. Wolf, DPM


 


In response to Dr. Freireich's recent post, I am compelled to respond to all issues pertaining to the MACRA/MIPS conundrum that we are facing. MACRA/MIPS is "supposedly" all about creating an environment of cost-effective and efficient delivery of healthcare services. Of course, this is being constructed by our federal government...a highly inefficient, wasteful organization. We, once again are the victims of their ineptitude. I liken their skillset to an orchestra conductor who can't read sheet music...and we're forced to play on. MACRA/MIPS is like all the other poorly concocted schemes foist upon physicians under the guise of trying to make healthcare delivery more efficient.


 


I submit that the additional data collection and additional data mining is a waste of time. Issues of meaningful use, quality measures, MACRA/MIPS and the like are created for one reason only...to reduce reimbursement. Collectively, medicine is the only "government contractor" (recipient of public tax dollars under Medicare, Medicaid, FEP...) that gets "incentivized" by not getting "penalized". By submitting the data bundled in our insurance billings, we are providing more than ample information as to our individual practice patterns and utilization. That, in fact, should be enough. After all, it really is all about how much less we can get paid, and not how well we do our jobs. It would be nice if all doctors could resume the practice of treating patients and not focus on treating their computers.


 


Arnold B. Wolf, DPM, Sterling Heights, MI

07/15/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: George Jacobson, DPM


 


Since this topic has come up again, I would like to remind everyone of a posting that I wrote on 03/05/2016. You can search it in the PM News archives. In a nutshell, here is the main excerpt, "We received a letter from Palmetto GBA stating that they have received information from the National Supplier Clearinghouse (NSC) indicating  that we have not billed the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) within the last four consecutive quarters."   


 


George Jacobson, DPM, Hollywood, FL 

07/15/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Martin G. Miller, DPM


 


I went to the website that Dr. Kesselman referenced in his response, and after putting in my NPI, it correctly identified me and my specialty (podiatry), but it only said revalidation: TBD. I assume this means "To Be Determined". I guess I have to keep checking back to see if any date actually shows up. It would be far more helpful if the actual date was given.  


 


Martin G. Miller, DPM, Freeport, NY

06/14/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: P David Applegate, DPM


 


Congrats on making it to your third year! Before all, it's important to be aware of what kind of job you feel you'll fit best into. Podiatry has grown into a field with an array of practice options. This is something you'll have to answer and it will be based on your training and personal interests. Once you've gotten an idea what you're looking to do, it's never too early to start working towards finding a job. In fact, if you end up finding one in a state you weren't originally planning on going to, it's critical that you are aware of timelines on state licensing. In short - the earlier the better. Relevant job listings can be found in a number of places. A Google search will go a long way towards finding ones outside of PM News


 


There's also nothing wrong with taking an active approach and reaching out to every practice/hospital/etc. in a given geographic area that you're interested in and asking if they'd consider hiring you. The worst they can say is no, and many may know someone in town looking to hire someone. Other options include a year of advanced training in a fellowship, but make sure you're aware of the timelines and nuances of the application process. A list of ACFAS-recognized fellowships can be found here.  


 


P David Applegate, DPM, Katy, TX

06/12/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1c


RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)


From: David E Gurvis, DPM


 



I recently had a request for 50 charts to be reviewed. That was a very unusual request, but that is not my question. The insurance company said if I wanted to give them access to my online EMR, they could log in and review those charts in that fashion.  


 


While that sound convenient, more so than printing them all out, it just sounds risky as it relates to privacy concerns. Has anyone allowed an insurance reviewer into their EMR? Is that even legal?


 


David E Gurvis, DPM, Avon, IN


06/12/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B


RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)


From:  Cynthia Ferrelli, DPM


 



I have experienced the same problem, so I came up with a solution several months ago that has been working fine. When my office is called for a chart review, we say we will comply but that their reps come to my office, will have to pull all the charts themselves, and find what they need in the chart. We tell them that this is how we do it and we set the guidelines. Set your boundaries. You are paying your staff to do work for you, not for the insurance companies. We seem to do enough of that already.


 


Cynthia Ferrelli, DPM, Buffalo, NY


06/12/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A


RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)


From: Matthew B. Richins, DPM, Cynthia Ferrelli, DPM


 



When we get a request, my office manager charges a fee for our supplies and her time to the companies, to be paid in advance. Most pay. Others ask to send a representative out to make the copies. We tell them to bring their own paper, printer, and ink - and they do!



 


Matthew B. Richins, DPM, Joplin, MO

05/19/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Microscope for KOH Preps (David Kahan, DPM)


From: Carl Solomon, DPM


 


I've been doing KOH preps for a while and they're simple. KOH preps don't require a special microscope. No oil immersion, polarization, etc. are needed. You just need low/med power (10X, 40X, occasionally 100X). An adjustable condenser to increase contrast may help but you can do without it.


 


Carl Solomon, DPM, Dallas, TX

05/06/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Gary Dorfman, DPM Retires After 50 Years


From: Peter J. Bregman, DPM 


 


Dr. Gary Dorfman has officially retired from 50 plus years of podiatry. Dr. Dorfman is a former president of the American College of Foot and Ankle Surgeons. He has given much of his time and talent working in various aspects of podiatry and has helped thousands of patients and left his impression on his fellow colleagues.


 













Dr. Gary Dorfman



 


His most recent employment was at the Foot, Ankle, and Hand Center of Las Vegas. He finished his last four years of practice doing what he loves and creating bonds with his patients and colleagues that will last forever. Though he is leaving our profession, he will be fondly remembered for his contributions and we wish him well in his retirement.


 


Peter J. Bregman, DPM, Las Vegas, NV

04/25/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: David Gurvis, DPM


  


I also have a missed appointment fee. I find the “threat” alone reduces missed appointments. Do I apply the fee uniformly? No. Actually, I hardly ever use the fee unless a patient has been egregious in repetitive missing of appointments. What I find then is that if I apply the fee, the patient goes away. The desired result. They fire me and I don’t have to discharge them!


 


I don’t have the fee on new patients as it is too difficult to make sure that they understand my policy, but if they miss two appointments, I refuse to take them back. As always, there is common sense. Missing an appointment without a call later is frowned upon more than missing with a call later that indicates the patient is sorry and had a lapse in memory or perhaps a real reason.


 


David Gurvis, DPM, Avon, IN

04/21/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Neil B. Levin, DPM, Mark K Johnson, DPM


 



We have been extremely pleased with the Konica Sigma CR units. We have three of them in different offices. The base unit fits on a countertop and we use our own X-Cels without any modifications or retro-fitting. It produces great images and and has excellent tools. Lease or loan payments are about $550/mo. for 60 mo. It was our best investment ever!


 


Neil B. Levin, DPM, Sycamore, IL


 


We went with the DR system A2D2 from Foz Networks (Zac Childress) , retro-fit to our X-Cel system in 2013.  Lease to own. The A2D2 is very reliable and have good support with minimal issues. Highly recommended.


 


Mark K Johnson, DPM, West Plains, MO


04/18/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Lynn Homisak


 


I believe you are asking ‘should you bill a new patient you haven’t even seen yet?’ and ‘should you collect their credit card information prior to their appointment?' Instead of applying a Band-aid on an obvious problem and sending a negative message to patients before you even meet them, why not try to determine the reason WHY new patient cancellations are such an issue for you? 


 


Yes, new patients must occasionally cancel an appointment. It happens. It is not typical, however, to have a new patient cancellation "problem"; unless of course, new patients are scheduled so far out that...


 


Editor's note: Lynn Homisak's extended-length letter can be read here

04/17/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Paul Kesselman, DPM 


 


There is no simple solution to this and there are multiple factors here. On one hand, asking for a credit card deposit on the phone does set a bad tone, but with high deductibles and co-payments and tight schedules, last minute cancellations are also unfair to other patients who otherwise would have been able to obtain care sooner. 


 


I agree that calling the patient the day before to confirm is far better than collecting a credit card "deposit" on the potential new patient. However, the reality is that tight schedules and last minute (24 hours is last minute) cancellations are unfair to...


 


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

04/17/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From:  Brian Kiel, DPM


 


I have a different perspective on this issue. Even though it can be aggravating to have no- shows, perhaps you are better without them in the first place. Those who do that frequently will be the ones who will not follow instructions for care, especially post-op or with wounds. I prefer not to have those patients in my practice. Also, another aspect is that we do slightly overbook on purpose and when there are no- shows, which happens every day, it leaves me a chance to "catch up.


 


Brian Kiel, DPM, Memphis, TN

04/15/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Paul Busman, DPM, RN


 


I wouldn't require a credit card guarantee. Right off the bat, even before you'd established a doctor-patient relationship, you'd have shown distrust for that new patient. You've also suggested that getting their money is more important than taking good care of them. Missed appointments are a fact of life.


 


A better way would be to call that potential new patient the day before the appointment and remind them of the date and time, and tell them how much you're looking forward for the chance to care for them. 


 


Paul Busman, DPM, RN, Frederick, MD

04/15/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Ivar Roth, DPM, MPH


 



Missed first appointments were a continuing source of irritation in my practice. We now take a credit card from all first time patients and bill a nominal amount to make sure the card is real. This amount is deducted from their visit if they come in. We send a confirmation email immediately after they call with a copy of our policy so there is NO miscommunication.  


 


This has worked well for us. Those who refuse to give us a credit card do not get an appointment. This is a real simple solution. We only charge $75 if they fail to show up or give notice. This policy is really to keep the new patient mindful that our time is valuable when they book an appointment.


 


Ivar Roth, DPM, MPH, Newport Beach, CA


04/14/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: G. Dock Dockery, DPM


 


I have never seen the dilute 4% dehydrated alcohol version available commercially. It is usually supplied in the 98% version of ethanol and is listed as Dehydrated Alcohol for Injection, USP. I think it is still available online or through Moore Medical Supplies.


 


G. Dock Dockery, DPM, Seattle, WA

04/11/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Paul A. Galluzzo, DPM


 


Try Gill Podiatry. They usually sell it in 5ml bottles.  


 


Paul A. Galluzzo, DPM, Rockford, IL 

04/07/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Kudos for NYCPM Galway Seminar 


From: Patricia Lee Walters, DPM


 


I just returned from a fantastic seminar for wounds and podiatry in Galway Ireland. The lectures were great and the Galway Bay Hotel venue was phenomenal. I think every podiatrist should check this group out for next March's seminar. There were excellent lectures and a cadaver workshop was included. The seminar featured world renowned lecturers. Dr. Susan Rice was amazing in the cadaver lab. Thank you NYCPM. 


 


Patricia Lee Walters, DPM, Tarzana, CA

04/06/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Elliot Udell, DPM


 


Dr. Secord shines a light on the fact that the exorbitant price of brand name medications charged by pharmaceutical companies to U.S. citizens could not be totally justified by the cost of research. Much of this research, as Dr. Secord points out, is done at institutions funded by taxpayers.


 


Even if we want to give an inch to big pharm's argument that research expenses are at the heart of why Americans pay so much more than "Canadians" for pharmaceuticals, it by no means explains how drug companies have cornered generics and raised the prices to astronomical levels. All of us are aware of how big pharm was able to exploit a legal loophole and start charging over ten dollars a pill for Colchicine when as a generic it sold for pennies for a tablet.


 


Econazole cream which is a generic antifungal, used to cost less than two dollars for an 85 gram tube. Somehow, the pharmaceutical firms were able to corner that market and raise the price to over $250 dollars for the same product. The ingredients in the EpiPen for which the company charges over $650 dollars (which we all have in our emergency crash carts) are available for less than $2 dollars. The bottom line is that the American citizens deserve close government scrutiny of what is going on and laws to protect its interests.


 


Elliot Udell, DPM, Hicksville, NY 

04/06/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Paul Kesselman, DPM



 


When Medicare Part D first was announced, I was asked to research and write an article on the subject. To my astonishment and much to my chagrin, the pricing of drugs was not set by the government but by private insurance carriers and the industry. This and other issues such as the donut hole, deductibles, etc. have left many seniors in a position of having to choose  food or medicine. 


 


Many split the doses of medications which may have not been engineered for such a procedure. Some I am told even end up in the ER due to the untoward toxic effects of the resulting...


 


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


03/14/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: John V. Guiliana, DPM, MS


 


The editor's comments to this are very accurate. "Rules of thumb" are dangerous and the last thing that you want to rely upon since it could mean the difference of a hundred thousand dollars or more if the practice is large enough. Variables in value are created by the extent of buyer risk (known as "capitalization rate"), the calculation of free cash flow, a list of tangible assets, and many additional "factors of production", such as the ability of the buyer to replicate the current revenue stream. A practice of any notable size should most certainly invest in having a professional valuation done.


 


If I were to reluctantly advise on what RANGE most podiatry practices sell for, it would be quite a big dollar range as it extends from 1-1.25 X NET earnings to 55% of GROSS. Again, for a large practice, that dollar amount could result in a large swing using simple generalities. Seller financing is a common option with a buyout over 3-5 years, and this term naturally would affect the purchase price. 


 


John V. Guiliana, DPM, MS, Little Egg Harbor, NJ

03/13/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


This is just one more reason to stop accepting Medicare patients. What could a certified orthotist or prosthetist know about casting that we don't know? Why should we stand still for being treated like trash? And, when did Medicare start paying for L3000s, anyway? 


 


Robert S. Steinberg, DPM, Schaumburg, IL


 


Editor's comment: The dilemma is that when Medicare enacts a rule, most private insurers follow suit.

03/06/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Bret M. Ribotsky, DPM


 


I had a very pleasant meeting with the new president of Merz this morning. He was unaware of the situation and assured me that he will assemble a team within the next two weeks and figure out a solution. He said, "Merz very much values its long-standing relationship with podiatric physicians and will do everything it can to continue this relationship.” I’ll remain diligent and persistent with this issue. I’m confident that before the DERMFOOT meeting at the end of the month, the ability to obtain Radiesse will not be an issue for those who are trained to use it.  


 


Bret M. Ribotsky, DPM, Boca Raton, FL