From: Paul Busman DPM, RN
In my opinion, this would be a bad idea, even if it's legal in your state. The reason goes back to the whole ludicrous and demeaning concept of "routine" foot care. When a patient comes into your office, she may be coming for the express purpose of "just" having her nails trimmed, but as a doctor of podiatric medicine, you are (or at least should) be doing a lot more. If nothing else, that patient receives a vascular and dermatological evaluation of the lower extremity. The simple act of asking the patient, "how have you been since your last visit" often elicits information that warrants further medical evaluation. If you're able to watch that patient walk in, she automatically gets a brief gait analysis. We all do these things subconsciously all the time, in addition to "just" cutting the nails.
Is there anyone here who has NOT discovered more serious conditions while "just" cutting a patient's nails? A beautician simply isn't trained to make these evaluations. If they miss a medical condition, resulting in serious complications, guess whose butt they're going to come after. Yours!
If your practice is that busy that you can't handle the load, it might be time to consider an associate who will bring in income (more than $100 per hour) by performing many more valuable podiatric medical services other than "just" cutting nails.
Paul Busman DPM, RN, Frederick, MD
From: Elliot Udell, DPM
Multi-dose vials are totally legal and acceptable. Our suppliers still sell multi-dose vials of anesthetics, steroids, and other injectables. If we do opt to use multi-dose vials, we as physicians must wipe off the top of a multi-dose vial with alcohol prior to each usage in order to clean off any dust that might have landed on the top of the vial. The most important point, however, is to never take a syringe and needle already used on a patient and re-insert it into the same vial.
Some clinicians might argue that they will use the same syringe and multi-dose vial for the same patient and after refilling it multiple times, they will discard the vial, the syringe, and needle; thereby preventing any threat of spreading disease. In theory, that makes sense, however it is a bad habit. In the hustle and bustle of medical procedures, it is possible that an inattentive staff member could place a half-full potentially contaminated vial back on the shelf, exposing other patients to potential harm.
Elliot Udell, DPM, Hicksville, NY
From: Jeffrey Kass, DPM, James Christina, DPM
I read Dr. Neil Goldberg's posting on LCD for mycotic nails with respect to chart documentation. The questions he raises are spot on. What particularly bothers me as an APMA member and advocate is where is our association, and what are they doing in respect to these particular problems? I would love to get an email, "we are aware of the current change in LCD wording and are all over this our lobbyists and lawyers are working around the clock to stop these changes in their tracks." Instead, I hear rumblings of the CEO making half a million dollars or more while I'm hustling to try to pay the bills. And incidently, when these 2025 Medicare decrease payments kick in, are APMA fees going to be lowered as well?
Jeffrey Kass, DPM, Forest Hills, NY
Local Medicare Administrative Contractor (MAC) issues are best addressed on a state or MAC-regional basis through the CAC representative and the state association, whose efforts are often coordinated and supported by APMA. Members are encouraged to contact their CAC representatives (a list is available at apma.org/cacpiac) with questions regarding their MAC or LCDs. APMA stands actively ready to help the CAC reps or state associations when needed, especially on issues with a regional or national impact. CAC representatives in cooperation with APMA have done outstanding work recently to identify absent ICD-10 codes in carriers’ LCDs and to work with the MACs to ensure changes are made and podiatrists’ claims are processed correctly.
In the past month, APMA has coordinated CAC efforts (including conference calls to set strategy and provide updates) for Palmetto (Skin Substitutes Draft LCD), NGS (RFC LCD), Cahaba (RFC LCD), and Novitas (HBOT, Strapping, Nerve Injections LCDs) CAC representatives. The CAC representative structure continues to be an invaluable resource to APMA members. APMA will hold its annual joint meeting of the CAC and Private Insurance Advisory Committee (PIAC) this weekend in Washington, DC. Watch for news and updates from the meeting next week.
James Christina, DPM, Executive Director APMA, Bethesda, MD
From: Rebecca Brickman, DPM
I would love to hear from one of the members of the Joint Committee on the Recognition of Specialty Boards (JCRSB) who denied the appeal from the ABPM. So far, we have only heard from a chair of the CPME, who basically just explained who was responsible for allowing this to happen. He did not express his opinion on how to fix it or why they denied the appeal. I want to know how a committee comprised of my "colleagues" could come to the decision to deny a podiatrist, who completed a 3-year residency the ability to sit for the ABPM exam simply because their residency doesn't have the word "medicine" in it. It's absolutely ridiculous.
I have been contacting the CPME for a year and a half regarding this issue. My calls and emails were not returned. I was ignored and was told that it wasn't their fault that this happened. I was then told by the director of the CPME that the ABPM needed to make a formal appeal. They did. And it was denied. I have copies of the formal appeal and the denial from the JCRSB. This is all a bunch of bureaucratic nonsense which is affecting the livelihood of hundreds of podiatrists like me. I am absolutely disgusted! I don't care whose fault it is...just fix it!
Rebecca Brickman, DPM, Newtown, CT
