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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:


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

09/15/2017    

RESPONSES/COMMENTS (NEWS STORIES)


RE: The Fury of Irma Floods Florida


From: Kyle Kinmon, DPM


 


"To those who have been temporarily displaced from their practices due to Hurricane Irma, we would like to help. We have time slots in fully operational, staffed offices in Martin, Palm Beach, and Broward Counties available for temporary use at no charge. Email Kkinmon@gmail.com.


 


Kyle Kinmon, DPM, Boca Raton, FL

09/02/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Paul Kesselman, DPM


 


I would like to congratulate the entire PM News staff on the momentous occasion marking their 6,000 issue. It is truly a remarkable achievement for Barry and everyone else involved in putting this almost daily publication together. This effort occurs whether in their home office, on the road at meetings, or on vacation, with the small team working diligently to produce a high quality newsworthy editions.


 


The ripple effect is even far greater in that it has made many of its contributors far better speakers and writers than would have otherwise been possible. Congratulations on a job well done and looking forward to number 10,000.


 


Paul Kesselman, DPM, Woodside, NY


 


Editor's Note: This topic is now closed.  We thank all of the readers who sent letters or called congratulating us.

09/01/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1


RE: The Rain Of Terror in TX


From: Marc Glovinsky, DPM & Associates


 


Our practice is offering assistance to Houston area podiatrists with patients who may now be located in Southeast Louisiana. Our practice can assist with patients who are displaced to the New Orleans area as a result of Hurricane Harvey.  email: office@footankledoc.com


 


Marc Glovinsky, DPM, Celia Storey, DPM, Denise Johnson, DPM

09/01/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Joe Starr, DPM


 


I’m a real real old timer, having graduated from the New York Podiatry School in 1940. I look forward to reading PM News daily. I retired thirty years ago and at 99 years old,  I still  dream of being back in practice. My very best wishes to you Barry and I wish you “a hundred un twonzek" years (120) in good health.


 


Joe Starr, DPM, Delray Beach, FL

08/30/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Tip Sullivan, DPM


 


Congratulations and a BIG thank you for what you have done for our profession! I cannot tell you how your work comforts and informs those of us who reside and work in areas without many colleagues to talk to daily!


 


Tip Sullivan, DPM, Jackson, MS

08/29/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Multiple Respondents


 


Thank you Barry for all you have done, are doing and will do.


 


Mark Feldman, DPM, Fort Lauderdale, FL. 


 


Congratulations on your decades of success. You have provided a service that in my opinion is invaluable to our profession. 


 


Jon Purdy, DPM, New Iberia, LA


 


Congratulations to Barry and Hermine Block on the 6,000th issue of PM News and to David Kagan who works with them the Podiatry Management Magazine side of these publications. All of your readers work very hard in their practices and hospitals with very long hours, etc. At the same time, very few realize the time and effort it takes to put together a daily e-newsletter in conjunction with the magazine monthly publication. What appears seamless to the reader does not come close to reflect the work involved on the backend, especially with a very small staff. 


 


Steven Kravitz, DPM, Winston-Salem, NC

08/28/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2A


RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 


From: Bret M. Ribotsky, DPM


 


I believe Hal’s way is too difficult. I suggest that everyone go to this website and look up "podiatry" in their city, and drill down on the top twenty codes that your competition are using, and you can easily see where you are. This data base is incredibly valuable on many issues such as trends that others are appreciating in your locality that you may be missing.


 


It's also fun to see which doctor in your community is making the most money. On the other hand, what an incredible invasion of privacy! There's no website to look up what patients are receiving from the federal government in assistance; it's only the doctors who must share everything. 


 


Bret M. Ribotsky, DPM, Boca Raton, FL

08/28/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2A


RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 


From: Melissa Lockwood, DPM


 


Dr. Ornstein makes good points regarding RAC audits, but there are a few things to clarify. In reality, the government has not focused on "random" audits in quite some time. They have been specifically targeting those providers who lie outside of the standard deviation of the bell curve for any given procedure - which in many cases is ANY one of us depending on if we see "more" or "less" than a particular type of patient - i.e. diabetics with ulcerations.


 


That said, it's critical that we all have access to the same information that CMS has in order to remain enlightened and to be aware of billing trends. I use my EHR system's  (TRAKnet) Code Audit Compliance feature (which aggregates and reports my utilization of codes  benchmarked against 2000 other users), as well as the information I glean from their monthly Virtual Practice Optimization (VPO) analysis. It's invaluable in identifying both overutilization as well as under-utilization across all of my providers in the practice so we can evaluate and adjust our coding habits accordingly.


 


Melissa Lockwood, DPM, Bloomington, IL

08/28/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Multiple Respondents


 


Congratulations Dr. Barry Block! 6,000! A record for the ages. WOW.


 


Art Helfand, DPM, Narberth, PA


 


Happy anniversary. I look forward to my daily dose of PM News. You are a blessing to our profession. Keep up the good work!


 


Rich Hofacker, DPM, Akron, OH


 


I want to thank Dr. and Mrs. Block for doing such an excellent job for PM News and Podiatry Management. I enjoy the daily emails and the monthly journals that you have been producing for all these years.  I hope they are able to continue at least until the 12,000th issue.   


 


Steve Berlin, DPM, Baltimore, MD

08/28/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Multiple Respondents


 



A huge hug and congratulations to Barry for issue 6,000 of PM News. Many in our profession would not have the knowledge base and ability to keep up with relevant news and trends in podiatry without this valuable publication. 


 


Hal Ornstein, DPM, Howell, NJ


 


It's just a truly outstanding contribution to our profession. Dr. Block is a pioneer with a great vision to help many. I cannot think of another individual who has worked as hard as Barry to bring educational information and news to advance podiatry. I thank Barry for this, and wish all the best of good health for the years to come. 


 


Robert Weiss, DPM, Darien, CT


 


Congratulations to Barry Block, his lovely wife Hermine, David Kagan, and all of my friends at PM News on their 6,000th issue. This is a truly remarkable accomplishment. Thank you for all of your fine work.


 


Richard Mann, DPM, Delray Beach, FL


08/25/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1


RE: PM News Marks 6,000 Issue Milestone


From: Bret Ribotsky, DPM


 


It’s beyond words to think what an incredible accomplishment this has been. For almost 25 years, Barry Block has been the protector, godfather, and social barrister of our profession. I look back at the hundreds of letters that I have written to the readers of PM News and how Barry and his wife Hermine made editing corrections to focus my comments correctly.


 


I am touched with how we as a profession could never have advanced so well without their daily teamwork. I’m sure each of the readers make reading PM News a daily ritual that can’t be missed. I can’t wait for issue 10,000 in 2028 and to see where our profession will be.  


 


Bret Ribotsky, DPM, Boca Raton, FL

08/25/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Hal Ornstein, DPM


 


The announcement that Medicare is going from random-based audits to outlier audits can have a great impact on many practices. If you are utilizing codes significantly more, or even less than the average podiatrist, you are at much higher risk of audits. These audits will be quite difficult to defend, especially if they involve over-utilization. Of course, if you have a large wound care practice, for example, you will be on top of the curve with wound debridement codes, which is by all means okay. 


 


I recommend that you run a CPT analysis in numerical order CPT 1xxxx – 9xxxx for the last...


 


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

08/23/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Robert S. Schwartz, CPed


 


In our forty three years at Eneslow, we too have seen a significant increase in average shoe size equivalent to the UK research. It is important to understand that English, or UK, shoe sizes are longer than American shoe sizes. On average a UK man’s size is one size larger than an American man’s size. Size eight UK is a size nine American. According to their research, the average UK man’s size is the equivalent of an American size eleven. On average, a UK woman’s shoe size is two to two and one half sizes larger than an American woman’s shoe size. A woman’s size five is the equivalent of American size seven to seven and a half.


 


According to their research, the average UK woman’s size is the equivalent of American size eight to eight and one half. English and American shoe sizes increase 1/3” per size; 1/6” per half size. Euro sizes (adults 35 to 45 women’s, up to size 50 in men’s) increase ¼” per size; 1/8” per half size. Most American shoe companies provide footwear for up to American size 11 in women’s, up to American size 13 in men’s. There are quite a few companies (including Eneslow) that offer larger sizes in both men’s and women’s.


 


Robert S. Schwartz, CPed, NY, NY

08/21/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dale Feinberg, DPM, CPed


 


I quit the diabetic shoe program years ago when there were 57 charts on my desk that were being audited. I realized the government wanted me to provide the service but at my expense. WE have become podiatric monitors.  We can identify a condition but are not allowed to treat it or be reimbursed if we do. As Jim Morrison said 50 years ago, "This is the end....."


 


Dale Feinberg, DPM, CPed, Yuma, AZ

08/19/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Bryan C. Markinson, DPM


 


Kudos to Dr. Paul Kesselman and other colleagues like him who navigate through the morass of regulatory BS surrounding the diabetic shoe program and DME in general. My participation in the Medicare diabetic shoe program ended abruptly after a very short time when the third patient complained about "rubbing me here," after the first said the "shoe is too heavy" and the second had a complaint I can't recall. It was over for me then, gladly.


 


I hear from the industry that many DPMs are not "taking advantage of this wonderful opportunity."  After reading his latest explanation of the singular issue of code A5513, and what I am hearing from some who have had audits, I strongly urge any DPM on the fence about participating to NOT participate. It's the smart move. 


 


Bryan C. Markinson, DPM, NY, NY

08/18/2017    

RESPONSES/COMMENTS (NEWS STORIES)


RE: Update on HCPCS A5513 Insole Code


From: Paul Kesselman, DPM


 


Here are some additional details regarding the A5513 posted in PM News and the APMA Weekly Focus: In mid-July 2017, the DME MAC and PDAC issued a joint bulletin concerning A5513 (custom inserts for patients with diabetes only). This bulletin stipulated that only those custom inserts  manufactured with raw materials using either a physical positive mold or those molded directly against the patient's foot are the only accepted methods for fabrication. 


 


It further went on to say that those manufactured in any other fashion (e.g. custom milling via the use of virtual positive images) were unacceptable. Lastly, the bulletin indicated suppliers would be held responsible and have to...


 


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

08/15/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Sang Hyub Kim 


 


Thank you, Dr. Barney,  for the constructive feedback. I was not aware of specific opportunities and venues available in the U.S. for current podiatry students to participate and to learn about MIS-style procedures.


 


The two-week exchange was not only limited to observing surgeries, but also exploring Polish culture and their medical system. You can find the full article here


 


Sang Hyub Kim (NYCPM Podiatry Student, Class of 2018)
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