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04/18/2016
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: The ACA and Where We're Going
From: David Secord, DPM
The mystery surrounding the current healthcare records and reimbursement debacle seems to continue unabated. The various authors of letters lament the absurd level of governmental intrusion into the physician/patient relationship and the resulting decline in quality of care, seemingly to turn providers into clerks and patients into chattel. What strikes me most about the outcome of the Affordable Care Act—neither affordable nor caring—is that its outcome is by design and predictably so. The rare bit of candor we’ve received on the Act comes from Johnathan Gruber—the MIT architect of the debacle—who admitted that the stupidity of the people would be manipulated to force this upon the nation.
Despite the protestations to the contrary, the obvious intent of the ACA was to bankrupt insurance companies (and, apparently, the Nation as a whole) and leave the federal government as the sole insurer. As a consequence of falling reimbursement, the intent is to leave only the federal government as the sole employer of physicians (unless you can afford to go the way of Dr. Bob Kornfeld).
The topic not broached as of this time is that someone voted for the people who shoved this down our throats and voted for them twice. The goals of the ACA were known when Obama was just a candidate for the Democrat nod for President and, yet, was still elected. To quote Pogo: “We have met the enemy, and he is us.”
David Secord, DPM, Corpus Christi, TX
Other messages in this thread:
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Donald R Blum, DPM, JD
Many years ago, I would have agreed with your hospital. That is the assistant should be as qualified as the primary surgeon. In the past, the assistant surgeon should have been able to give input to the surgeon and opinion during the procedure. However in today’s world a “certified medical assistant” is allowed to assist in surgery and in many cases also bill an assisting fee. Many times, this is out-of-network which greatly benefits the employing surgeon. This is possibly a good argument for allowing the DPM to assist on procedures with the privileged DPM.
Additionally, having a podiatrist assist whether trained in the particular procedure or not should decrease the OR time as the primary surgeon will be more efficient, and one could expect better outcomes as a result. Efficiency would occur as the assistant is more knowledgeable of the instrumentation and order of the procedure. Setting up power equipment, aligning a fixation wire or other hardware will be easier with a podiatrist, even one who does not do the procedure on a regular basis. The language and skill of the DPM assistant beats the knowledge of a “PRN” medical tech or a permanent OR medical assistant employed by the hospital but typically does general surgery or non-orthopedic procedures.
An item which the assisting podiatrist needs to check on is whether one's malpractice will cover them for these more involved procedures. Many times a doctor doing non-boney procedures will have a different medical liability coverage than one doing bone and tendon/ligament work.
Donald R Blum, DPM, JD, Dallas, TX
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ken Hatch, DPM, Herb Schmirer, DPM
I did get a notice via my state association. I first joined APMA in 1976. I am now a life member. When I tried to vote, it kicked out my password and number. When I called APMA, I was told that LIFE membership did not include voting rights. WE old guys saw the best and worst of podiatric medicine over many years. I guess the current leadership does not need input from our experience.
Ken Hatch, DPM, Annapolis. MD
I join the growing list of APMA life members whose vote is not important to the APMA. If my opinion is not good enough for the APMA, my money will not be either.
Herb Schmirer, DPM (Retired), Port Washington, NY
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Bret Ribotsky, DPM, Lawrence A. Santi, DPM
I’m eagerly awaiting APMA’s response to this issue before I send my check. Please choose wisely.
Bret Ribotsky, DPM, Fort Lauderdale,, FL
APMA values every member and their input, and we apologize to any life member who may feel disenfranchised by the current referendum. As background, eligibility to vote in a referendum is codified in the APMA Bylaws for each member category—the APMA Board of Trustees and staff cannot simply choose to allow life members to vote. The Bylaws, Procedures, and Rules Committee reviewed the privileges afforded each member category as part of its comprehensive review of APMA’s governance documents and included the current privileges that were adopted by the 2019 House of Delegates. Life members are not the only category of members who are ineligible to vote. For more information on eligibility, check out our FAQs about the referendum at www.apma.org/referendum.
The philosophy of the committee has been that members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum. So, life members, who are retired from practice, would not be affected by language designed to support scope of practice modernization.
I have heard your concerns, and the Bylaws, Procedures, and Rules Committee will consider the feedback we have received from life members at its fall meeting. To be clear, changing the bylaws would require action by the APMA House of Delegates, so any changes will take time. I thank you in advance for your patience and understanding.
Lawrence A. Santi, DPM, President, APMA
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Steven J Berlin, DPM, Carl Solomon, DPM
I read that several retired podiatrists have felt slighted by not being able or being denied the opportunity to voice their opinions on current events affecting the profession. That certainly needs to change. I suggest a column of current situations affecting this great profession. We need a special column in the newsletter drafted by senior editors and/or Journal to encourage the opinions of us older podiatrists
Steven J Berlin, DPM
I acknowledge, but don't agree with the philosophy that life members are ineligible to vote because "... members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum."
That makes about as much sense as not allowing voting rights to members who are employed by a hospital or other institution, because they may not be affected by certain issues that would have a greater impact on private practice docs. Some issues affect everybody and some issues do not affect everybody. We cannot permit our membership to be fragmented like that.
Carl Solomon, DPM, Life Member, APMA
Editor's note: This topic is now closed.
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Eric J. Lullove, DPM
There are numerous multilayer compression systems on the market for management and treatment of venous leg ulcers. They are not “replacements” of an Unna boot. They are specific for a different diagnosis code set. Multilayer compression systems should be billed with the I87.xxx series ICD-10s. The CPT code for those systems is 29581. The code is not a substitute for making a multi-layer compression from your supplies — this code was designed specifically for the compression system kits that are manufactured by 3M, Urgo, Milliken, Hartmann, et al.
You must document the need for edema control, CEAP or VCSS clinical documentation for a VLU or venous hypertension (or hyper congestion) as well as the failure of conservative therapy of elevation and stockings. You also should as a caveat have a recent ABI dated from the initial onset of the venous event or ulcer and any other additional vascular studies (venography, for example). As always, it’s about documentation, documentation, documentation, especially with wound care services.
Eric J. Lullove, DPM, Coconut Creek, FL
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: APMA Wants My Money, Not My Vote
From: APMA Member
APMA excludes Life members from voting, then asks for money. I feel quite disappointed that the recent referendum about the new definition for podiatric physician that APMA is seeking approval for has excluded life members from voting. Who better than people who have longitudinal knowledge and experience to be able to shed insight into this process?
And then the same week, I receive a lifetime member contribution form with APMA asking for $150 from me. I have always paid this contribution amount to APMA, but this year I’m refraining from doing so because obviously if my vote doesn’t count, neither does my money.
APMA Member (Verified)
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrists Should be Doing Their Compliance Due Diligence
From: Lawrence Rubin, DPM
Due diligence refers to the reasonable steps that should be taken by a person or business entity in order to satisfy legal requirements. This diligence should include complying with the Medicare Office of the Inspector General (OIG) strong recommendation to have a provider and staff written compliance plan that is implemented and kept up-to-date.
There is no better way to avoid unintentional coding and documentation errors from resulting in an audit that can lead to potentially devastating punitive actions. This is because the OIG is on record for saying: Having a provider and staff (including outsourced billing staff) compliance program can be a mitigating factor in the decision of whether or not we (OIG) effect punitive action.
If you are a solo or small group practice owner or manager and are interested in knowing more about Medicare compliance matters, discuss this with your healthcare attorney or a qualified compliance consultant.
Lawrence Rubin, DPM, Las Vegas, NV
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Steven Finer, DPM
After reading Dr. Tomczak’s post, I reviewed the various boards in Pennsylvania. The Podiatry Board is the only medical one that requires two physicians, save one other. Physical therapists, require one. I have not researched the history of these board hand holdings. Somewhere in our past, podiatrists needed a lot of guidance, lest they stumble and do something idiotic. It seems that chiropractors, optometrists, and dentists do not need any help.
Steven Finer, DPM, Philadelphia, PA
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From Paul Kesselman, DPM
Orthotics are custom fabricated, custom fitted, off-the-shelf, etc. Some companies advertise their wares as being able to cure everything and custom fabricated. While not every consumer can sniff out the snake oil salesman as medical providers, it is our job to report those who violate the law! Each state has different board regulations on who can dispense orthotics. If a company is marketing custom fabricated or custom fitted orthotics to the consumer, there are often state laws limiting this activity.
One can identify the 20 or so states which strictly regulate who can provide orthotic devices. By visiting the NPE West contractor at NSC, one can search under tools bar for a particular state's licensure database for all sorts of DME. Here you can find your state's licensure requirements for dispensing all types of orthotic devices. If you find that you practice in a state requiring a licensure and should the orthotic manufacturer be marketing directly to the consumer, this may be a reportable violation of the state’s laws and must be reported. There may be different regulations between custom fit, off-the-shelf and custom fabricated orthotics. So one needs to be careful to check all three benefit categories (OR1 =Custom Fabricated, OR2=Custom Fitted; OR3=Off-the-Shelf).
It is important to note that while this information is available on a Medicare contractor's website, the NPE contractor is using your state's board information and this is updated on a fairly regular basis. Thus, it is both fairly reliable and accurate.
Paul Kesselman, DPM, Oceanside, NY
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: False Advertising about Orthotics? (Vincent Gramuglia, DPM)
From Elliot Udell, DPM
Dr. Gramuglia brings up two issues. One is whether a non-medical professional can prescribe orthotics. The other is whether a provider, professional or non-professional, can promote their product as being a panacea for all sorts of non-pedal ailments.
Anyone can legally sell foot orthotics. We are all aware of the Dr. Scholls machines in Walmarts, and orthotics sold on the internet via Amazon as well as in all sporting goods stores.
Whether a vendor can make a claim that his or her orthotics can cure herniated discs, scoliosis, or other systemic ailments is a legal matter and most states have district attorneys who investigate fraudulent claims made by any vendor selling any sort of product. Perhaps Dr. Gramuglia should call his local DA's office and report the matter.
Elliot Udell, DPM, Hicksville, NY
08/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Fay Sharit, DPM
Courses that meet this requirement can be found for free on pri-med.com.
Fay Sharit, DPM, Glen Rock, NJ
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: John Throckmorton, DPM
I find it interesting that the DO school which Dr. Michael’s daughter is attending won’t let him do the white coat ceremony for his daughter. I was allowed to do this for my daughter at the DO school in Michigan and also help the Dean give her diploma to her after her four years at the graduation ceremony. After being in practice 30+ years in the state, to be with our daughter, we moved to North Carolina
She was the first DO doctor to do the palliative fellowship at Vanderbilt and she was, at times, talked down to because of her DO degree. Professional degrees status varies in different states and around the world. I believe that Michigan’s DPM status is due to the fact we had the first residency in the country at Civic Hospital in the early 60s. I am hoping that the number of residencies continues to grow in the states where we lag behind in them, and through interaction with not only our colleagues, but other health professionals, i.e. MDs, DOs, and other recognized providers.
John Throckmorton, DPM, Moorseville, NC
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jose Aponte, DPM
I am sorry to hear that your daughter was denied the privilege of your being able to put the white coat on her future White Coat Ceremony at her present school of osteopathy. In my opinion, this sends the wrong message to the new students. Recently, I attended my son's WCC at a medical school and was allowed to put the white coat on his shoulders without any controversy.
As I understand, the WCC was designed by The Arnold P. Gold Foundation. I would contact this foundation and let them know your situation. Maybe they have a position that you can present to the osteopathic school your daughter is attending and hopefully help change their thoughts about all this. Regardless of the outcome of this situation, your daughter should be very proud of you for being a DPM.
Jose Aponte, DPM, Caguas, PR
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Stephen Musser, DPM
I disagree with your daughter's school decision. If the state where her school is located includes podiatry in the definition as a physician, then I think you or your daughter can argue/refute the administration's decision. I once had an MD/DO point out to me that I shouldn't be parking in a physician designated parking spot. I politely told him I am considered a physician in the eyes of the Ohio medical board and left my car where I parked it. Nothing came of it and nothing more was said.
Stephen Musser, DPM, Cleveland, OH
07/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Student Indebtedness
From: Ira Kraus, DPM
I have been watching this item with particular interest. I think that this is an important opportunity for our colleagues not only to donate themselves through the APMA Educational Foundation, but to also impress upon the companies we support that they need to give back, using PICA as an example, to make a meaningful impact on the lives of our students pursuing careers in podiatric medicine and surgery.
When Talar Medical was founded, we made a commitment to address this issue and we to date have donated $50,000 toward student scholarships. We believe that every contribution can make a difference. However, to effectively combat student debt and promote access to education, we need more companies to join us in this cause.
I encourage you to impress upon the companies you utilize to consider how they can contribute to the APMA Educational Foundation. By donating to this worthy initiative, we can help alleviate the financial burden on students and encourage the next generation of healthcare professionals. Together, we can work toward reducing student indebtedness and fostering a brighter future for those entering the podiatric field.
Ira Kraus, DPM, Whitefish, MT
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Medical School Debt
From: Paul Kesselman, DPM
According to a recent report, average medical school debt now is greater than $200,000. Many states now have programs which help to erase some or all of the debt. Why is podiatry school debt which likely is as much if not more than the average medical school debt not provided with these same programs? Where are the schools or APMA with respect to obtaining the same level of financial relief for these students/residents/young practitioners?
Students are already encumbered with hundreds of thousands of dollars in undergraduate debt. The thought of taking on another $200K plus dollars in debt for podiatry school and then working as a resident for 3 more years is often a non-starter, deterring many from entering our profession.
I cannot fathom starting a family with the amount of debt these young people are faced with. The future of every practitioner and the APMA is in our students. The APMA and colleges must make this issue a priority. Podiatry school debt relief should receive the same relief programs as the MD/DO students/residents/young practitioners.
Paul Kesselman, DPM, Oceanside, NY
07/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Has APMA Appointed Future Action Strategists?
From: Lawrence Rubin, DPM
At all times, healthcare professional organizations responsible for public outreach and relations usually have appointed future actions strategists. These qualified persons constantly monitor the standing its members have in changing aspects within the healthcare marketplace, including any significant changes in reimbursement issues.
I have been a member of APMA since 1958, and I am hoping that the APMA has done now what it has done in the past by appointing qualified strategists during these rapidly changing times (such as was done prior to change of the name of the profession from chiropody to podiatry). If it has, these strategists are realizing that the quickly advancing Medicare spearheaded transition from fee-for-service reimbursement to value-based care (VBC) is already devaluing payment for elective, "non-life threatening” surgery, and it is increasing the reimbursement value of prevention and chronic disease management E/M services. In podiatric medicine, chronic diseases include, but are not limited to diabetes peripheral neuropathy (DPN) and peripheral artery disease (PAD).
I am concerned about this because recent board certification discussions that appear to ultimately put, "most of all of podiatry's eggs in one surgery basket" could, to say the least, be counterproductive for the profession of podiatry.
Lawrence Rubin, DPM, Las Vegas, NV
06/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrists Self-Identifying as" Dr." or "Physician"
From: Carl Solomon DPM
Putting aside the discussion of whether or not podiatrists are physicians, I’d like to express some thoughts about how we address ourselves in that context. I can hardly recall an instance in which one of my MD/DO friends addressed him/herself as “physician”. When asked, or introduced, it’s “I’m an oncologist, orthopedist, rheumatologist, general surgeon…”, whatever. My dentist friends aren't too proud to be identified as a dentist...perhaps when appropriate, oral surgeon. Not physician.
And when I see the use of the term “Dr.” written in front of somebody’s name without other explanation, almost without exception, that’s a de facto acknowledgement that “I am not an MD”. This was personified on the sign-in sheet at one of my hospitals’ Dept. of surgery meetings. Everyone signed in simply with their name, with the exception of two, each of whom signed “Dr. Xxxxx”. You can guess…
A podiatrist may achieve some level of recognition by assigning him/herself the title of "Dr." or "physician", and the inference is that it represents being an MD. But oftentimes once the details come out, the concealment of the identity as a podiatrist makes it apparent that there is a low level of self-esteem associated with such identity. So whatever special recognition may have been achieved by initially identifying as a Dr. or physician, is actually negated. On the other hand, if one is humble and is acknowledged by another party as being a doctor…podiatrist, the level of recognition will remain high. If you can’t take pride in being a podiatrist, you should have spent the time and effort doing something else!
Carl Solomon, DPM, Dallas, TX
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: AI and Podiatry
From: Lawrence Rubin, DPM
As podiatry board certification matters are bringing the profession closer and closer to there being mainly surgery limited practices, we'd better figure out a way to combat present and future bad AI public information. Let's say a footsore person gives AI this question: "Where can I go to get this big, red, sore bunion taken care of?"
It surely will not be to the benefit of the patient or podiatric surgeon for the AI answer to be, "Go to the Walgreens store nearest you. Ask the pharmacist where you can find bunion shields to reduce pain and inflammation caused by shoes and also Tylenol for bouts of intense pain." Forewarned Is Forearmed. We have to prepare ourselves to deal with AI. It’s good to see that APMA will have a lecture on AI at its August meeting.
Lawrence Rubin, DPM, Las Vegas, NV
06/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Allen Jacobs, DPM
I suggest this article for all PM News readers.
Allen Jacobs, DPM, St. Louis, MO
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jack Ressler, DPM
Why pay someone thousands of dollars to evaluate your own practice when all they are going to do is look over your numbers without even making an in-person evaluation of your office? They will offer to come out and evaluate your practice but at an even higher price. You can save money up front and sign a contract with other companies that will charge you a percentage of your sale price but you are at their mercy and cannot control the extent at which they advertise your practice. Signing with one of these companies gives them complete control of the sale of your practice even if you find your own buyer. I doubt they will give you exclusions.
Who better to value your practice than yourself? It is you who know your patients, staff, physical office set-up, demographics, and numbers better than anyone. The valuation of your practice comes down to one simple thing and that is the number a potential buyer is willing to pay. When I sold my main practice in 2016, I advertised it in the classified section of this forum. I did all of the work myself and paid a very reasonable amount for advertising and...
Editor's note: Dr. Ressler's extended-length can be read here.
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Hal Ornstein, DPM
I highly recommend Mike Crosby, CPA of Provider Resources as a practice appraisal expert. He has performed this service for hundreds of podiatry practices and been doing this for many years. He is responsive, knowledgeable, and fair to all parties involved.
Hal Ornstein, DPM, Howell, NJ
05/21/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry/Chiropody and Surgery
From: H. David Gottlieb, DPM
Surgery has been part of podiatry's DNA since its founding. While looking through some old pictures, I found some I took of my uncle's 1933 graduation picture from the Illinois College of Chiropody and Surgery. l am happy to share this picture if anyone needs confirmation that Surgery was part of the College's name and our profession's scope. Additionally, if you review back issues of Chiropody Reports or its defunct successor Podiatry Reports, you will also find many articles regarding surgical procedures of the foot. They may not be talar-calcaneal fusions, etc., but surgery has been a part of the average chiropody/podiatry practice from the beginning.
The concept of pay at time of treatment is also not new. Back then, medicine of all types was cash only. My father, who joined his brother's practice in 1943, has related to me that he would co-sign bank loans for his surgical patients. He rarely if ever had a default since the patients were so grateful that their pain was gone.
What's old is again new. I believe that medicine and surgery in the U.S. should be practiced along the model created by the Veterans' Health Administration. Call it the Civilians' Health Administration, dispense with the insurance companies as well as all other government-run health entities. Pay us a fair salary, reasonable working hours, evidence-based treatment protocols. Cash-only could still exist and even thrive for those with the knack for it.
H. David Gottlieb, DPM, Baltimore, MD
05/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Employed vs. Self-Employed Doctors
From: H. David Gottlieb, DPM
I recommend everyone reading this to also read a fascinating book by the Nobel Prize winner in economics - author Daniel Kahneman. The book is called Thinking, Fast and Slow.
There is a relevant passage regarding the statistical likelihood of financial success, a topic currently being debated here. I quote from page 257: "More generally, the financial benefits of self-employment are mediocre: given the same qualifications, people achieve higher average returns by selling their skills to employers than by setting out on their own. The evidence suggests that optimism is widespread, stubborn, and costly."
One should keep this in mind before setting out on their own.
H. David Gottlieb, DPM, Baltimore, MD
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