Spacer
PMbanA7-513.jpg
Spacer
PresentBannerCU1117
Spacer
INGBannerE215
Podiatry Management Online


Facebook

Podiatry Management Online
Podiatry Management Online


PMBannerG9_513

Search

 
Search Results Details
Back To List Of Search Results

01/11/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


When minimalist running, one reduces heel contact running, which for most of us, would be a good thing. Runners must be willing to break in their new stride, speed, and distances slowly to reduce fractures and other overuse injuries such as Achilles tendonitis. These rules apply when breaking any new activity or sport.  


 


The article states, “These days, more of Kirby’s patients are running with thicker-sole shoes than ever before. Every third runner he sees wears Hokas, a sneaker brand with the thickest underfoot cushions in the market today." I must interject that they may be dangerous for many runners. I published a white paper regarding Sketchers Rocker Shoes. I eventually wrote the 41 page brief involved in the successful lawsuit against Sketchers Rocker Shoes involving 300 injuries.


 


Rockers and flexible soled shoes designed to shock absorb and create cushioning using thick and flexible materials when married to the flexible foot types of many runners, will result in injuries to some of those feet, especially if runners transition too quickly. Rockers obviate the need for healthy internal biomechanics and predictably allow feet with high SERM-PERM Intervals to degenerate to the point that they need rockers all the time. Hokas are unproven short- or long-term as to safety and they are being poorly disclaimed. They are not the next Nike Waffle Trainer yet!


 


Dennis Shavelson, DPM, NY, NY

Other messages in this thread:


01/19/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


Peg Swisher is a board-certified pedorthist or CPed and stating that her CPed certification makes her “an expert in biomechanical evaluation and gait analysis” is a claim undeserved of that profession. I have known and worked with CPeds who are in fact experts in biomechanical evaluation and gait evaluation, but they are exceptions and not the rule. Most CPeds are not exceptionally educated, trained, or experienced in advanced biomechanics.


 


Being a board-certified pedorthist makes you a board certified pedorthist and nothing more.


 


Dennis Shavelson, DPM, NY, NY

01/15/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Lawrence M. Rubin, DPM


 


I suggest that Dr. Borreggine's prognostications for the podiatric implications of Medicare service bundling be considered carefully. I would like to add another prognostication: Those entrepreneurial podiatrists who band together into local foot care independent practice associations (IPAs) capable of negotiating group bundled fee agreements with guaranteed cost containment and value-based features to ACOs will gain the major segment of the foot care delivery market share in any given locale. 


 


Lawrence M. Rubin, DPM, Las Vegas, NV

01/12/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Joseph Borreggine, DPM


 


Riddle me this Batman: What looks like a DPM, walks like a DPM, and can do what a DPM can do outside of foot surgery, but is not a DPM? Batman: Great Scott!! Why an NP of course! The tea leaves certainly do not reveal another story based on what Medicare announced yesterday  along with what was posted on PM News


 


Bundled payments are here to stay for Medicare providers and fee-for-service is dead! Voluntary it will be to start, but in a few years it will be the norm. To get this going, CMS will offer monetary incentives to providers who are early adopters. And based on this new policy of reimbursement being implemented, there will no longer be the ability in place for providers to bill for...


 


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

01/12/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Allen Jacobs, DPM


 


Just a word of advice from an old guy who has been there before. There is some recent early enthusiasm for the use of a polyvinyl alcohol implant in the 1st MPJ. Please remember that the induction period for implant-related pathology can be prolonged. The polyvinyl alcohol great toe implant is NOT synthetic cartilage. We have no long-term data to suggest that the ultimate fate of such implants may not parallel that of Silastic, UHMW polyethylene, or other materials subjected to adhesive or abrasive wear. 


 


The only available studies which I can find were corporate supported case series reports. This implant may or may not be useful in the long term. However, be careful prior to overzealous use of this material as any implant or implant material.


 


Allen Jacobs, DPM, St. Louis, MO

12/11/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Richard Mann, DPM


 


Tom DeLauro represents the very best of our profession. He is a brilliant clinician, surgeon, and educator. He has been an exemplary role model for all who have known him and those of us fortunate enough to have been trained by him. It is with great affection and respect that I wish him the very best on his retirement.


 


Richard Mann, DPM, Boca Raton, FL

12/11/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Charles Lombardi, DPM


 


A point of clarification from Dr. Rogers’ note. If a fellowship is approved by our accrediting agency (CPME), then and only then, they may have available funds, so a CAQ is unnecessary. Also, there is some confusion as to funding of fellowships. They are generally paid at half the direct funding of the program and all of the indirect costs, but there is a caveat. I cannot find in the Federal Register that other than geriatric and community health, fellowships are reimbursable, although speaking with my allopathic colleagues, I learned that they are getting reimbursed in other specialties. The one thing that is for sure is that fellowships approved by non-accredited agencies in the eyes of the federal government are definitely not reimbursed.


 


Charles Lombardi, DPM, Bayside, NY

12/04/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


I know Drs. Positano and Morelli well for many years. I would stand up for them in debate and send my children to them for care. It saddens me to see them take time from the fruitful lives that podiatry has delivered them to publicly and personally sabotage each other. They represent two sides of the podiatry coin that has existed throughout my career that we cannot seem to get beyond. I have lived on both sides of the coin successfully so I stand as proof they can co-exist on the same planet.


 


One side expertly states: “never operate”. They point to the cripples that foot surgery predictably but rarely delivers as collateral damage seemingly blind to the benefit that our surgical prowess delivers to countless feet. The other side expertly states: “cutting toenails and corns, dispensing orthotics, and providing non-surgical performance enhancement and preventive and quality of life upgrades is below the pay grade and dignity of a DPM.


 


To paraphrase Charles, “these types of debates do not further our profession or either side.” Wearing their bias on their sleeves weakens podiatry in general and lessens them from becoming the colleagues they were meant to be. If I could, I would share the phone numbers of these men with each other and suggest that they cross-refer, co-author articles, and lecture on the same podium. Instead, both of them with good intentions, foster the curse of podiatry here and elsewhere.


 


Dennis Shavelson, DPM, NY, NY

12/01/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Charles Morelli, DPM


 


I certainly agree with our colleague Dr. Positano that cosmetic foot surgery is riskier than other cosmetic procedures, as we certainly do not walk on our faces but the entire comment that follows (from “experts”) has nothing to do with cosmetic surgery nor does it paint an accurate picture of podiatric surgery as it is done today (in my opinion). 


 


Most cosmetic procedures performed on the foot usually revolve around hammertoes or relatively simple bunion procedures for the purpose of fitting in shoes and looking more attractive in open shoes. With the exception of an arthroplasty, very few foot procedures involve...


 


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

11/29/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Dennis Shavelson, DPM


 


I must disagree when Dr. Quan states that a leg-length becomes significant “if it causes pain”. My assessments have always been that a leg-length discrepancy is significant if it is causing a positive FEJA test and at least three (3) confirmations as described here.


 


When you consider that 70%+ of all humanity has a limb-length discrepancy (Caselli & Rzonka 2002) and less than15% of all custom foot orthotics have a one sided lift built in to adjust for limb-length (personal investigation, 2006), most LLD is left untreated by current peer podiatry standards.


 


Dennis Shavelson, DPM, NY, NY

11/29/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Bret Ribotsky, DPM 


 


What a great letter from Dr. Dan Klein. Integrity is your most important quality and it is such an important lesson to all. I am sure most of us have been approached with a “fast way to make money.” Time has taught me that there is no fast way to the top. As Zig Ziegler has said, “The elevator to the top is always out of order.” Once you lose your integrity, you can never get it back, and we all know a few DPMs who are for sale. Do we really listen to them? Bravo, Dr. Klein.


 


Bret Ribotsky, DPM, Boca Raton, FL

11/27/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dan Klein, DPM


 


I provided podiatric services to about 10 nursing homes for about 20 years. I advised patients about the “routine foot care” clause and collected fees from the patient’s family. I was approached by a Chicago-based company run by a podiatrist, who asked me to work for them doing essentially routine foot care for a salary. They would, in turn, bill CMS for these services. When I explained to this company that these services were non-covered, and I would not commit fraud, they suggested that I diagnose conditions that would allow them to bill for the services. 


 


When I refused to collude with this company, they advised me that my relationship with these homes was in jeopardy and they would find another podiatrist who would work with them. To my dismay, I was advised by these same homes that my services would no longer be needed and they were going with another podiatrist who would do these services. So after 20 years of service to these homes, I lost out to a podiatrist who would create diagnoses, and often embellish conditions that didn’t exist for each resident.


 


Years later, the same Chicago-based company was cited by the Federal Government and the owners of the company were fined and going to prison for fraud. My integrity cannot be bought! Without integrity, a podiatrist, a doctor, a person is nothing!


 


Dan Klein, DPM

11/25/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Steven J. Kaniadakis, DPM


 


Reading interesting stories like this is yet another good reason that PM News is so valuable a resource for the community!


 


Steven J. Kaniadakis, DPM, Saint Petersburg, FL 

11/25/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Janet McCormick, MS


 


Texas has mandated that nail salons have autoclaves and thus began the charade of their use by many salons, such as putting implements in previously used pouches when nothing but a quick rinse was performed; there are many more "fake sterilization" practices. Also, there is the 


problem of the low number of inspectors to keep up with the requirements. More laws and mandates do not work; Texas proved it. Requiring an autoclave in nail salons means nothing. Just more autoclaves are sold to perpetrate a false premise. 


 


I am glad to report, however, that many salons are grabbing onto safety as their mantra. The technicians are trained to...


 


Editor's note: Ms. McCormick's extended-length letter can be read here

11/23/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Michael Schneider, DPM


 


I worked for Aggeus for a short time back in 2011. After a few months, I was told by the owner, Zev Gray, that I was “low man on the totem pole in billing.” When I responded that all I was doing was routine care, Gray gave me recommendations on how to up-charge. “Squeeze the back of the foot and if the patient jumps, you can bill for a posterior tibial tendinitis”. I replied that most [patients] were in wheelchairs and were being seen for routine care. Gray got "personal", and I quit. The moral of the story is to be true to your profession. Zev, his partner, and his wife have all had their day of reckoning.


 


Michael Schneider, DPM, Denver, CO

11/22/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: David Zuckerman, DPM


 


I applaud Dr. Spalding’s drive for mandatory salon instrumentation sterilization. It’s an important goal for public welfare and safety, but there are other factors that, in my opinion, are just as important; for example, proper medical work-up for salon clients as well as proper technique and treatment. I have observed deep debridement of diseased ingrown mycotic toenails by nail techs who have no idea what could happen when you take a sharp instrument and push and expose the nail eponychium. But is there a solution? It could start with podiatrists reaching out to the nail salon industry and working together. Podiatry schools: where are you?


 


David Zuckerman, DPM, Cherry Hill, NJ

11/21/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Robert Spalding, DPM


 


Many states do not allow you to bring your own instruments and that would be in violation of some state regulations. Many times, the instruments brought from home are shared with others in the family who have a nail infection, and are not properly sterilized. Storing contaminated personal instruments that could cross-contaminate other instruments in a salon is no answer either. 


 


However, a better protocol has emerged. The Boston public health department has mandated new standards by implementing autoclave sterilization for salons above and beyond what the Massachusetts cosmetology board requires. Boston for the last 2 years requires... 


 


Editor's Note: Dr. Spalding's extended-length letter can be read here.

11/20/2017    

RESPONSES/COMMENTS (NEWS STORIES)


RE: NY Podiatrist Urges Those Using Nail Salons to Bring Their Own Instruments

From: Janet McCormick, MS



Suggesting a patient take her own implements to a nail salon sounds good, but it most times is not. Most of them will NOT wash them after use, and then drop them into their purse in a plastic bag for use on the next visit. The microbes love that environment and multiply greatly. This means re-introduction of their own highly multiplied microbes back onto their feet on the next visit. And many times, that is just as bad as the technician transferring another client's microbes onto them. If they do wash them (a spritz?), they usually do not have the capability of disinfecting or sterilizing them - still contaminated.



I suggest that you tell your patients to check with their friends to find a salon that is known for their cleanliness - though even that can be deceiving. They might also call salons to ask if they have an autoclave; even ask if their technicians are trained in the use of asepsis in their services. If the salons do not know what the word asepsis means, then suggest your patients go elsewhere. And keep trying to find a safe salon.



Janet McCormick, MS, Nailcare Academy


11/07/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Elliot Udell, DPM


 


The survey quoted said that the reason why so many physicians are cutting back on their hours or opting out of medical practice is due to psychological burnout. The causes given in the paper published by the Mayo Clinic were varied. I know two general surgeons in my area who gave up doing general surgery and only do wound care. I know one young internist who was quite successful who gave up. Many internists are now opting to no longer see patients in the hospital, something which has sadly become a trend. 


 


The article said that the clerical work which burdens physicians such as EMRs is one piece of the puzzle. Another cause is that to escape from the obscene burden of paperwork and low payments due to Obamacare plans, many physicians are joining hospital- or corporate-run practices hoping to avoid stress and increase their income only to find themselves with other burdens and no ability to control them. 


 


I wonder how large is the "burnout" problem that affects podiatrists. How many of us reading this have experienced feelings of burnout that have caused you to consider reducing your hours or to enter a different career?


 


Elliot Udell, DPM, Hicksville, NY

11/02/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Evan Meltzer, DPM


 


Kudos to PM News for publishing a list of the highest paying jobs in San Antonio, TX. I was proud to see that on this list was the annual mean wage for podiatrists at $231,140. This is $75,000 more than the highest salary paid to senior VA podiatrists nationwide. Senate bill S. 1871, the VA Provider Equity Act, is now in the Senate Veterans Affairs Committee. If released by the Committee and passed by the full Senate, this bill would fairly compensate VA podiatrists as physicians for the equal work they do. The current "out of touch with reality" pay scale has been present for decades, and in my opinion, constitutes occupational discrimination. 


 


If passed, the trickle-down effect of this bill would be substantial. Equality with physicians in pay and promotion opportunities within the VA would no doubt follow at the Indian Health Service, Public Health Service, and in the branches of the U.S. military. Now is the prime time to write your U.S. Senators to ask for their support of this vital legislation. The passage of this bill would be a win-win for the entire profession.


 


Evan Meltzer, DPM, San Antonio, TX 

10/21/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Ron Freireich, DPM


 


Thank you for your response, Dr. Lehrman; however, you have completely missed the major point of my posts. I appreciate the timeline of MACRA that you spelled out, but my posts had nothing to do with that. Regarding your comment about the time I spent “crafting” my posts not making a  difference, you’re right, it didn’t because you failed to even mention the MedPAC report in your response, which is what my posts were all about. 


 


I never mentioned the lack of any medical association, including APMA not speaking out or lobbying against MACRA. That is in the past. My posts had to do with the...


 


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

10/19/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Jeffrey D. Lehrman, DPM


 


In my opinion, MIPS, which is part of MACRA, is an unfair, unjust, outrageous program which, in its current form, does nothing to improve quality of care, improve outcomes, or decrease cost. A brief timeline of MACRA: This all started when Representative Michael Burgess (R-TX) introduced MACRA into Congress. 


 


Your statement that there was no response from national organizations is incorrect. Every medical association I am aware of (including the ones you listed) spoke out against it, lobbied against it, and tried to...


 


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

10/11/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Ron Freireich, DPM


 


And now a another article discussing the recommendation by MedPAC to repeal and replace MIPS. The take away, I believe, from the MedPAC report is as follows. "The commission proposes eliminating the current set of MIPS measures and instead relying on population-based outcome measures, such as preventing hospital admissions or patient experience. The proposed outcome measures would be calculated from claims or surveys and therefore would not require burdensome clinician reporting," the report said. 


 


After reading this second article, I then went onto the APMA website as well as my EMR vendor's site to see how many webinars were created on MIPS, not to mention...


 


Editor's Note: Dr. Freireich's extended-length letter can be read here.

10/02/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Charles F. Ross, DPM


 


I would like to add a congratulatory note for the successful change in the orthotics rules proposed by CMS and the role that APMA had in aggressively providing information, along with the support of other aligned profession so that a potential injustice could be prevented from even being initiated. 


 


This is just one more reason why I am proud to have been a member of APMA for the past 45 years and to continue as a member via service in the VA. It is unfortunate that too many podiatrists do not truly understand the strength of their membership. I can only hope that more young people will see the benefits upon graduation so that the APMA will be able to continue to be able to perform pro-active protection for ALL podiatrists. It is my hope that those that have been lax may reconsider their membership.


 


Charles F. Ross, DPM, Pittsfield, MA

10/02/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Paul Kesselman, DPM


 


This incredibly hard fought victory is one that can be celebrated by every qualified professional who provides orthotics. The APMA has been fortunate enough to have some incredibly gifted and dedicated members who worked long hours on various committees and have over the years fostered relationships with other professional associations, including those representing orthotists (AOPA), AAOS and AOFAS (to name but a few). Being able to work closely with these organizations has positive spill over into other battles we all face. No doubt this has resulted in the recent passage of the House VA Parity Bill.


 


To those of you who have complained that APMA does not adequately represent you, let me just say that your ability to provide foot orthotics, AFOs (including CAM walkers), ankle braces, and custom AFOs has been preserved for the foreseeable future. This has been done with no quid pro quos to any of the other associations or CMS. Please consider the negative impact on your bottom line had this proposal passed. Compare that loss to the dues you are asked to pay. Hopefully, you will realize the annual dues are a small pittance compared to the potential losses you may have suffered.


 


Now it's onto the VA parity bill in the Senate and getting CMS to withdraw the preposterous new A5513 policy clarification.


 


Paul Kesselman, DPM, Woodside, NY

09/26/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


Ted Spiker, the author of this article published in Esquire Magazine, did podiatry a disservice in penning "the gluteus maximus and its brother muscles serve as foundational structures in our anatomy—ones that can prevent injuries, and ones that can make us stronger, faster, and healthier." Proclaiming the pelvic area foundational anatomy that makes us stronger, faster, and healthier in lieu of its distal cousin the foot, is a misdirection of fact.


 


To let the media and our own teachings and historians reduce biomechanics and basic podiatry to a reduced place in the sun will eventually mean the end of our profession as we know it. 


 


Dennis Shavelson, DPM, NY, NY
Amfit temp