Query: Standard of Care for Electric Debridement of Nails
What is the current standard of care in podiatry with regard to use of electrical drills for dystrophic toenails? Are podiatrists still doing this? If so, are the drill bits individually sterilized and used only once? Is the use of drills to debride dystrophic toenails still taught in the podiatry schools?
Norm Wortzman, DPM, Boston, MA
Query: Using a Call Center
I’m looking for recommendations for a call center to cover the phones during normal business hours? What are the positives and negatives in your experience?
Debra Manheim, DPM, Rego Park, NY
Query: Answering Service Capable of Making Patient Appointments
I am looking for a company to answer phones and make patient appointments when I am outside of the office. Is anyone aware of such a service?
Hal Ornstein, DPM, Howell, NJ
Query: Patient in Collections Threatening To Post A Negative Online Review
We have a patient whose account was sent to collections 7 months after treatment, and she is now threatening to post a "horrific" online review of our practice. How would you handle this situation?
We have our patients sign a financial contract that clearly states that past due amounts beyond 90 days will be turned over to a collection agency and an additional 38% will be added to the balance (30% collection costs, 8% interest). Statements were sent to this patient at 30, 60, and 90 days, and phone calls to the patient were documented by my accounts manager at 60 and 90 days. At 4 months, a "pre-collections" letter was sent to the patient.
She received 2 additional monthly statements before her account was sent to our collection agency. Within 5 days of the account being sent, she contacted my accounts manager and threatened to post a negative review if we didn't remove the collections fees and discount her remaining balance. My accounts manager explained to her that we had already been generous with the time she was given to pay and that she was responsible for the full amount. We are awaiting payment from the collection agency and anticipating a negative online review.
Query: New Medicare Numbers
On April 1, 2018, CMS will start changing Medicare numbers to different ones to protect patients from identity theft. I understand that there will be a grace period for the change-over. My question is this: Are we supposed to start changing the ID numbers in April 2018 and then bill Medicare accordingly for services rendered? If so, then will beneficiaries (patients) know to present the new Medicare number to us? Or will we need to start inquiring at that time? What about any nursing home patients that we may see?
Joseph Borreggine, DPM, Charleston, IL
Query: Source for Office Plans
I am looking to build a basic podiatry office and wanted some suggestions on where to obtain office plans that would meet general podiatry needs. I have some ideas but wanted some thoughts from people who have built an office.
Charles Myers, DPM Conway, SC
Query: Volunteering/Working as a Podiatrist in Peru
I am inquiring about information or advice regarding volunteering/working as a podiatrist in Peru.
Rachel George, England
Query: Lunula Laser
I would appreciate any feedback on people’s experience with the Lunula laser with respect to fungal nails.
Samuel Rosenwald, DPM
Query: Osseous Cysts Discovered During Bunion Surgery
The patient is a 56 year old healthy female teacher. A large osseous cyst in the head of the first metatarsal was discovered during scheduled bunion surgery. This cyst was not obvious on pre-op x-rays. It prevented the planned metaphyseal osteotomy of a modified Austin-style bunionectomy (“chevron”) as well as a possible Scarf procedure. The patient did not want a more proximal osteotomy (CBWO, Lapidus, Cotton) that would cause prolonged disability. Demineralized bone matrix was placed in the defect.
What is the consensus of podiatric surgeons in this presentation? I suggested a Mau-type osteotomy to help reduce the abnormal IM angle, thereby avoiding any osteotomy of the capital region. Post-operative weight-bearing on a protected basis would then be permitted. Is anyone performing the Mau procedure?
Query: Alternative to Answering Service
Are there any recommendations for alternatives to answering services which charge monthly fees? I would like to keep my cell phone number private from patients or others who call after hours. My current service is utilized just a few times a month.
John Scholl, DPM, Lady Lake, FL
Query: Stem Cell Therapy
I understand that stem cell therapy is being used to treat foot and ankle problems. Can anyone recommend a CME course or pertinent literature regarding this form of treatment?
Michael Forman, DPM, Cleveland, OH
Query: CMET Certification
Have any of my colleagues taken the CMET wound care certification examination? Any thoughts or counsel on what your experience has been would be appreciated.
Maryann Trivlis, DPM, Belle Harbor, NY,
Query: Inventory Management System
I am a partner in a multi-doctor, multi-office practice. I am looking for suggestions for an inventory management system. This system should be able to keep track of DME as well as smaller items (medical supplies, syringes, injectables, etc.). Ideally, it would alert us to when we are running low on a product so we would know when to order more. Does anyone have a recommendation?
Scott Werter, DPM, Myrtle Beach,SC
Query: CMS Changes
Two years ago, we were told that the global surgery days were to be eliminated. I have not heard any mention of whether this was implemented. Also, does anyone know the status on the exemption limits to the CMS quality assurance program? They currently are $30,000 with up to 100 patients and the proposed change was to $90,000 for up to 200 patients. The latter proposed change was reported here on PM News. This is a very important change for solo small practices. The impact from an elimination of the global surgery days will affect all practices.
George Jacobson, DPM, Hollywood, FL
Query: Pacific Medical for Digital X-Ray System
My office is in the market to purchase a DR x-ray system. I have recently been in touch with Pacific Medical who uses Metron software. I'm not familiar with this company but they do have very good pricing. Does anyone have any experience with this company, and could you inform me as to how happy you are with the DR digital x-ray system?
Peter Riznyk, DPM, Orchard Park, NY
Query: Hospital Call Schedule
The hospital I currently go to is planning on starting a non-paid call schedule. I'm trying to negotiate a paid call schedule because, in my opinion, non-paid is ridiculous. Why should all other specialties get paid while podiatry doesn't? Does anyone else experience this, and do you have any tips to negotiate?
Mike Zuri, DPM, Tampa FL
Query: Non-Allergenic Support Hose
Does anyone know of any support hose that are non-allergenic? My patient has tried several brands with no luck.
Robert Fridrich, DPM, NY, NY
Query: Shoe for Parkinson's Disease
I have a very close friend who has had Parkinson's disease for over twenty years. He is in his early 60s and has been doing relatively well. He does shuffle while walking and sometimes stumbles and trips. His shoes are mostly rubber composite designer footwear. I am researching shoes with less grabbing soles.
I know the SAS line would be good but I would like some other suggestions, especially if there are any designer shoes that would have a more forgiving sole for this type of gait. A leather sole is not an option due to insufficient padding. Any input would be greatly appreciated.
Query: Beneficial Insurance
I just received a very good quote from Beneficial Insurance for my malpractice insurance policy which is coming up for renewal. I have not heard anything, negative or positive about this insurer. I'm wondering if any of my colleagues have had any experience with them?
Deardre Nadel, DPM, Bronx, NY
Query: Options After Residency
I am beginning my third year of residency starting July 1st. I feel very excited and eager to begin my last year of training, however I have a lot of anxiety of the future. I feel completely lost as to when, where, and how I should be looking for a job and any other necessary things to do in order to prepare for the next steps. I am planning to apply for my state license in the state where I hope to work, but other than that, I'm not sure what else to do? I'm writing to see if there is any advice that can be offered. Also, I would like to thank PM News for the job postings. They are very convenient. Are there additional sources?
Query: Hiring a Registered Dietitian (RD)
In an effort to provide complete care to their patients, many hospitals in the area have begun offering diabetic counseling and meal planning sessions with registered dietitians (RD). I was considering hiring a registered dietitian and providing those services (and billing for them) in the office. This will help ensure that patients follow through with the referral, and it would also generate additional income for the practice. Has anyone else set up a similar arrangement? Are there any reasons why this shouldn't work? Would our scope prevent this arrangement or preclude billing for their services, even though the RD is practicing under his/her own license?
Jay Seidel, DPM Baltimore, MD
Query: Endoscopic Plantar Fasciotomy Blade/System
I’m looking to find a reasonably priced endoscopic plantar fasciotomy blade/system? Any help would be much appreciated.
Kyle J. Kinmon, DPM, Boca Raton, FL
Query: Life Coach to Help Rehab Patients
Would you refer patients to a life coach? What would be your thoughts and concerns about such a service? Would it help our patients who require additional reinforcement and support to meet their rehabilitation goals?
A. James Fisher, DPM, Crescent City, CA
Query: Kinesiology Tape?
What is everyone's preferred kinesiology tape to use? Which do you feel gives the best support, is waterproof, and causes minimal skin reaction?
Chad Friedman, DPM, West Chester, PA
We are considering installing a VOIP system in our offices. There seems to be a bunch of companies out there. Can anyone recommend a company? What are your experiences with them?
Nicole Kaiser, DPM, Delran, NJ