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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:


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

03/03/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Best EPAT for Plantar Fasciitis?


From: Dieter Fellner, DPM


 


I want to reach out to the podiatric community and colleagues to ask for their opinion and advice about shock-wave therapy treatment options, specifically for recalcitrant plantar fasciitis. I discovered there are several different, and confusing, options. After researching this online, I found that many doctors offer and market extracorporal pulse activation treatment (EPAT) shockwave therapy for recalcitrant plantar fasciitis. 


 


I followed up to read journal articles about the EPAT. There is, overall, a good degree of professional, confidence-inspiring online consensus from various sources to recommend this type of treatment. One such device, seemingly favored by a preponderance of podiatrists is the...


 


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

01/30/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Ed Cohen, DPM


 


If this patient came into my office, I would discuss her insurance and ask her if she would like information on where to get better coverage at a more affordable rate. If the patient was interested, I would tell her about our experiences and how we got a 39 year old employee a policy with a $5 co-pay for PCPs, a $10 co-pay for a specialist, a $250 deductible with a maximum out-of-pocket of $500 for $176 a month after the employee tax credit. This person also was a smoker and had cancer several years ago. Another employee, a 45 year old, found a policy for  $218 which also included dental and vision coverage with no deductible and a 30% co-pay on all medical and hospital bills. This policy has a $1,000,000 coverage limit.


 


We also ask our patients if they are interested in saving money on our prescriptions and if they are, we tell them about the GoodRx website. Every doctor should be familiar with this site because it can save the patient a lot of money. On expensive prescriptions, such as Zyvox, there is a number 855-239-9869 to call where the patient can get the antibiotic for free, based on income. 


 


Ed Cohen, DPM, Gulfport, MS

01/28/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Setting the Record Straight


From: Bradley Bakotic, DPM, DO


 


I'd like to set a rumor that has been circulating recently straight. Years ago, due the threat of Obamacare, and changes in reimbursement, Bako partnered with a private equity firm, thereby giving us a nest egg, in case the worst came to fruition. As it turned out, had we not done so, we likely would have been put out of business by the various adverse changes. It was one of the best, and luckiest, business decisions I've ever been fortunate enough to make. Recently, as that fund matured and their stock became available, another firm purchased that stock (recapitalized). I have never given up control of my company, and have retained ownership. 


 


At Bako, we're going to continue to support the podiatric profession; in fact, during 2017, we'll do so at the highest level ever. This profession is by in large awesome, and we're incredibly fortunate to have had its support through the years. Thank you!


 


Bradley Bakotic, DPM, DO, Alpharetta, GA

01/28/2017    

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



From: David E. Samuel, DPM


 


Several years ago, better vitamin therapy was introduced by a few companies that started showing better efficacy for diminishing neuropathic pain. You purchase the vitamins and resell them to your patients. You make a little on the vitamins and many times, patients feel better and are happy. 


 


Good clinical studies on it and biopsy, I'm sure, played a roll in determining what the vitamins ultimately did to warrant a trial with them. We have used these vitamins and some have seemed to give some moderate improvement and some have also not been helpful. It just depends on...


 


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

01/28/2017    

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



From: Bradley Bakotic, DPM, DO


 


I'm a bit confused by the post related to ENFD by John Hurchik, DPM and some of the subsequent responses, particularly that offered by Elliot Udell, DPM, who seemed to imply that clinical doctors, and their labs, are doing ENFD testing strictly for "massive" financial gain rather than optimal patient care. 


 


First, let me say that I have been informed that Dr. Hurchik did intend for his note to take the negative tone that it seemed to. Secondly, those that believe that a punch biopsy pays a "massive" amount of money, probably have never done a punch biopsy. The "massive" reimbursement for a punch biopsy is about $85.00. It might buy you...


 


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

01/27/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: $105 Office Visit Co-Pay


From: Keith L. Gurnick, DPM


 


Yesterday, a 25 year old female patient returned to my office for a follow-up visit, but with a new insurance plan beginning calendar year 2017. Her health insurance is an Anthem/Blue Cross PPO 60 EPO individual policy with a $105 office visit co-pay, and a $6,300 calendar year deducible. Should this really be called "Health Insurance" or just a major medical policy?


 


Keith L. Gurnick, DPM, Los Angeles, CA

01/27/2017    

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



From: Ed Cohen, DPM


 



I think if the patient has a good hgba1c, the procedure is safe. The nerve biopsy is slightly more accurate than a Sudoscan. The Sudoscan is a three-minute test where patients step on plates while placing their hands on other plates. I  think the Sudoscan is accurate enough to give you a good diagnosis and has the advantage of not having to treat a biopsy wound. Another great advantage the Sudoscan has is that you can safely run the test on any diabetic patient no matter how high their blood sugar, and the equipment can never cause an infection.


 


The  patient is usually more receptive to a non-invasive test and the Sudoscan is a good practice builder. The downside is insurance reimbursement, which used to be very good, but has now become a problem in the last few months. In some states, podiatrists are not authorized to use the machine. I have found the Sudoscan a great objective tool to evaluate the effectiveness of my treatments and selling the various nerve food products to the patients can also be a nice revenue generator. Patients also don't mind paying for the test when it is not covered by insurance.


 


Disclosure: I have no financial relationship to Sudoscan.


 


Ed Cohen, DPM, Gulfport, MS


01/26/2017    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Connie Lee Bills, DPM


 


I have been using simple Facebook ads for 2 years. I have a maximum of $5/day based on website clickthroughs. I love it and it reaches existing and new patients and they even have conversations about foot issues as a result. This is an awesome tool. I have not used Google yet, but be sure you have a Google place page (free) no matter what. It will make it easier for patients to search for you.


 


Connie Lee Bills, DPM, Mt Pleasant, MI

01/23/2017    

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



From: Jeff Kittay, DPM


 


Hooray! Finally the Boards will be accountable to SOMEONE. The high-handed attitude that many state boards have exhibited against the members of our profession may at last be at an end. More than twenty years ago, I was the victim of such board abuse which cost me two years of aggravation and nearly $5,000 in legal expenses before the board rescinded their accusations of professional misconduct (I had had the nerve to suggest in a malpractice case against another DPM that he had indeed violated the standard of care, an opinion with which I stand).  


 


I was advised at the time by my attorneys that the board members had “governmental immunity” and could say or do whatever they pleased without fear of retribution and that I could not pursue them to recover my costs. Perhaps the removal of such immunity by the SCOTUS will put the Boards on notice that their actions can indeed have consequences and that they must be more careful when making accusations or levying punishments. Those board members that feel that they must resign in protest to being held responsible for their decisions should feel free to do so and will not be missed by the profession.


 


Jeff Kittay, DPM (retired), San Rafael Norte, Costa Rica

01/23/2017    

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



From: Michael Forman, DPM,  Joseph Borreggine, DPM


 



Thank you Dr. Evans for warning us about the North Carolina Dental Board v. Federal Trade Commission decision. I was under the impression, obviously false, that you could not be sued for stating your opinion. Perhaps this decision can be used to punish "hired gun" experts who testify whichever way they get paid.


 


Michael Forman, DPM, Cleveland, OH


 


This has been an issue for many years. Click here.


 


Joseph Borreggine, DPM, Charleston, IL 


12/27/2016    

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



From: Steven N. Solomon, DPM, JD, Raymond F Posa, MBA


 


With the latest Yahoo breach, encrypting your email is a great idea. As a medical practitioner though, you need to make sure that the people you're communicating with are using the same email system as you are. You also need to make sure that you have a BAA signed with the email provider so as to be HIPAA-compliant. You may find it easier to use a patient portal for your communications as it forces the people communicating with you to do so securely. 


 


Steven N. Solomon, DPM, JD, NY, NY 


 


I recommend Zix Corp (zixcorp.com) to all of my HIPAA clients. It is fairly inexpensive and works seamlessly through Outlook. Also, along similar lines, if you need to encrypt your text messages, check out Tiger Text (tigertext.com)


 


Disclosure: I have no financial relationship to either company. I just have years of experience with them and they are solid reputable companies that offer outstanding service.


 


Raymond F Posa, MBA, Farmingdale, NJ 

12/27/2016    

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



From: David Cutler, DPM


 


For those of you who prefer evaluating newer surgical procedures with a bit more published research behind them, look at the European orthopedic literature on MIS bunionectomy. Most of these procedures are variations on the same technique, namely a through-and-through metatarsal neck osteotomy with aggressive lateral translation of the capital fragment along with a unique stabilization of the capital fragment using a 2mm K-wire as shown here. 


 













Post-op X-ray of SERI Bunionectomy



 


There are several of these published studies dating back to the early 1990s, but the most expansive is by Giannini, et al. in International Orthopedics, September 2013 entitled "A Minimally Invasive Technique for the Surgical Treatment of Hallux Valgus; Simple, Effective, Rapid, Inexpensive (SERI)" (PMID 23820757) with 1,000 cases. At first glance, this technique seems prone to non-union, though in this study, none were reported. Dorsal malunion was observed though only in 8 cases.


 


I’ve been doing open bunionectomy techniques since I started practice in 1988, though with robust studies on MIS such as these, I’ve started doing the SERI technique over the past several months. It is trickier to perform than you might expect, though patients do experience very little post-op pain and minimal swelling compared to open techniques, and they do appreciate the smaller scar.


 


David Cutler, DPM, Bellingham, WA

12/27/2016    

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



From: Martin S. Lynn, DPM, Jay Seidel, DPM


 



Sendinc.com is an excellent resource, providing options such as email destruction after a pre-determined time.


 


Martin S. Lynn, DPM, Oil City, WA


 


I use G Suite. It's the paid version of Gmail, Calendar, and Drive. You can sign a BAA with them and they are HIPPA- compliant. Also, it looks more professional, as you'll have youremail@yourwebsite.com. Pricing starts at $5/month per user for 30gb of storage, and for another $5/month, storage is unlimited.


 


Disclosure: I have no financial interest in Google's products.


 


Jay Seidel, DPM, Baltimore, MD


12/20/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Andrew Levy, DPM


 


I commend Dr. Loshigian for his letter and stance with Castle Connolly. It is important for each of us to speak up for the profession where we can.  For several years, their representative tried to sell me advertising space in the Top Doc issue in this area. Each year, I wrote a similar letter, essentially telling them I would consider an ad if and when they included podiatry as a classification. Now they have given up soliciting me, and unfortunately still haven't moved to a more enlightened inclusive focus. Keep up the good work Dr. Loshigian.


 


Andrew Levy, DPM, Jupiter, FL 


 


Editor's note: Write to William Liss-Levinson, PhD, VP, Chief Strategy & Operations Officer. His email address is: bliss-levinson@castleconnolly.com

12/19/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Time for Podiatrists to be listed as Castle Connolly Top Doctors 


From: Michael Loshigian, DPM


 


Well It's that time of the year again when Castle Connolly is open for nominations for its published lists of Top Doctors across the country. Every year, I nominate doctors that I have worked with closely and know to be among the best in their area of their specialty. Every year, it is a bittersweet experience as I cannot nominate deserving doctors of my own specialty. For as long as I can remember, podiatry has been excluded from this publication. 


 


This year, I have written to William Liss-Levinson, PhD, VP, Chief Strategy & Operations Officer. His email address is: bliss-levinson@castleconnolly.com


 


I have included my letter below as an example...


 


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

12/16/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Nutraceuticals and Diabetes


From: Paul Kesselman, DPM


 


I recently reviewed the following article available to Medscape subscribers regarding the use of nutraceuticals for the treatment of diabetic neuropathy. No matter the side of the fence you want to be on, this will be interesting reading and no doubt create some controversy. I wonder what others think.


 


Paul Kesselman, DPM, Woodside, NY

12/14/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Kudos  for New Residency Director


From: Stacey Baptiste, DPM


 


I would like to congratulate Jason E. Feinberg, DPM on establishing the first podiatry residency training program at Huntington Hospital at Northwell Health, Huntington, NY. Dr. Feinberg has been the Chief of Podiatry at Huntington Hospital for the past four years and worked diligently during this time to have a residency program established and approved by the CPME. This was an even greater task to accomplish as this would be the first residency training program of any medical specialty established at Huntington Hospital at Northwell Health.


 


Approval for three PM&S-36 residents was received earlier this year, and the first round of residents started their training September 1, 2016. Dr. Feinberg's program has been met with great success and he looks forward to future growth of the program as the hospital expands to meet a growing, challenging and diverse population.


 


Stacey Baptiste, DPM, Huntington, NY

12/09/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Eric Edelman, DPM


 


If Chase/JP Morgan Chase is available in your area, they are likely to be the lowest cost option for credit cards processing. Chase Paymentech is one of the 5 direct processors in the U.S., so there is no third-party involvement. Almost everyone else you talk to is going to be a third party which will add another layer of service fees. Also, if you move your operating account to Chase, you will have your daily settlements in under 24 hours (Monday's transactions have funds available Tuesday, etc.). Their equipment cost is reasonable too; we just got new chip- compliant terminals for $350 that can go to CAT-5 cable and your Internet router for fast processing times. 


 


Eric Edelman, DPM, Syracuse, NY

12/08/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Dane J. Myers, DPM, JD, Mark A. Hardy, DPM


 



I attended the Global Foot and Ankle Conference in Cleveland this year. As advertised, it included foot specialists from around the world. The lectures were timely and well presented by podiatrists, orthopedists, and others involved in foot care. Insights from specialists from around the world showed different perspectives on treatments. I highly recommend the conference.   


 


Dane J. Myers, DPM, JD. Springdale, AR



 


This is a legitimate meeting unlike some predatory conferences and spam emailings that we all receive from time to time. Current and past presidents and leaders from foot and ankle societies throughout the USA, UK, Europe, and the Asia-Pacific rim, founded this organization in 2015. The inaugural event was held in Cleveland, OH this past June. As a global organization, GFAC will rotate the annual meeting to a different host country each year. Much like the Olympics, each host country will bring its own flare and cultural contributions to the annual congress. 2017 will be in Chongqing, China; 2018 will be in Milan, Italy; 2019 will be in Delhi, India. Faculty and council members are comprised of ACFAS, AOFAS, EFAS, APSFAS in addition to many other national/international organizations. GFAC is an organization designed to be inclusive (MD, DPM, DO, PhD, PT, RN, etc.), not exclusive. Thus, the organization’s name: Global Foot and Ankle Community. 


 


Mark A. Hardy, DPM, Cleveland, OH

11/17/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Podiatrists and Diabetes


From: Robert Creighton, DPM


 


According to the CDC, more than 1 in 3 adults have pre-diabetes and 9 out of 10 do not even know they have it. The foot complications associated with diabetes are well-known, but I would venture to guess there is also a higher prevalence of foot problems presenting to our offices who are either directly or indirectly associated with metabolic syndrome/pre-diabetes. A just released study in JAMA Neurology found an association between metabolic syndrome components and polyneuropathy. 


 


I believe our training programs should create podiatrists who can confidently counsel their patients who present with the metabolic dysfunction that places that patient on a path towards diabetes and its life-altering complications that we know all too well.


 


Robert Creighton, DPM, St. Petersburg, FL

11/14/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Dermatoscopes and Amelanotic Melanomas (Daniel Chaskin, DPM)


From: Elliot Udell, DPM


 


Kudos to Dr. Chaskin for advising all of us to use dermascopes in our practices. I have been using one for several years and picked up two melanoma cases as a result. In one case, the patient's primary care doctor looked at the lesion and felt it was benign. The patient went to a dermatologist who also visually examined it and made the same misdiagnosis. As a result of my examination with a rudimentary dermascope I bought on Amazon for less than 150 dollars, the patient was properly referred, and to this day thanks me for saving his life.


 


There is a learning curve in dermoscopy and one pathway is a website called derm101.com. You can access dozens of case studies where they show you pigmented lesions viewed by the naked eye and then how they appear under a dermascope. They further show you slides of the lesions after a biopsy was done. There are also many textbooks available on the subject.


 


Elliot Udell, DPM, Hickville, NY

11/12/2016    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Dermatoscopes and Amelanotic Melanomas


From: Daniel Chaskin, DPM


 


There may be dermatologists, podiatrists, and other healthcare practitioners who are surprised when the results of a pathology report come back as amelanotic melanoma. Here are some useful ideas: 


 


1. Read the section "Amelanotic and Hypomelanotic Melanoma" in the second edition of the Atlas of Dermoscopy.


2. Attend medical seminars which include dermoscopy as a topic.


3. Request that future podiatry seminars include learning about dermatoscopic images that could be sent along with biopsy specimens to a pathology lab. Dermoscopy provides additional horizontal information often missed by the naked eye. This additional information is helpful to the pathologist in best sectioning the specimens to ultimately arrive at a more accurate diagnosis. Without this information a dermatopathologist might miss a lesion's surrounding pattern of pseudopods. 


 


Daniel Chaskin, DPM, Ridgewood, NY 
MinX-ray