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04/22/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Michael Schneider, DPM


 


Keep your license at least for a few years. You never know what may come your way. 


 


Michael Schneider, DPM, Denver, CO

Other messages in this thread:


10/14/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Brian Lee, DPM


 


I guess I'm old school. In my opinion, Foredom cable drills are still the best. I still have 2 that I've been using for over 30 years! They have much better low-end torque than Osada, even with their stepdown handpiece. Not as compact, but definitely less expensive. 


 


Brian Lee, DPM, Mt. Vernon, IL

10/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: George Jacobson, DPM


 


Drs. Jacobs' and Shea's comments go well with my recent posts about the “no show” new patient. There is a change as they both described which leads to the lack of keeping a new appointment as they are still just rude customers. Maybe they even order food and don't pick it up. Once these new customers are seen by us physicians, most of us naturally convert them to patients who do garner some respect for our care. 


 


Most value the physician-patient relationship that we develop and become lifelong patients that help build our practices. There was another old adage that says "like refers like." When I first started in practice, I saw everyone's worst patients. In some cases, I was their 4th podiatrist. A well-established colleague and friend, Henry Merritt, DPM, told me not worry that someday I'd be able to "weed the garden." Pull out those weeds (charts) that don't have you feeling better after they leave. Yes, our lives matter too! If there is no legal need for me to follow a patient, we just won't invite the rude customer back. I hope you noticed that I turned them from a patient to a customer.


 


George Jacobson, DPM, Hollywood, FL

10/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Connie Lee Bills, DPM   


 


I am shocked. I wouldn’t have actually touched the child, but definitely would have insisted that the mother deal with it immediately. I’ve had a similar situation during a procedure with a child. It was horrible.


 


Connie Lee Bills, DPM, Mt. Pleasant, MI 

10/12/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Denis LeBlang, DPM, Nick Turner


 


There is a company in Los Angeles called Osada, Inc. They have the equipment that you need to drive the Shannon 44 burr. You will be happy with their equipment. 


 


Denis LeBlang, DPM, Congers, NY


 


Many physicians have opted to use the Osada Portable All-in-One PEDO-30W drill unit along with the Shannon for in-office MIS. DocShop Pro carries this unit and all other Osada units. Additional saw options are available as well to complement your Shannon.


 


Disclosure: I am the Vice President of DocShop Pro.


 


Nick Turner

10/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C



From: Jack Ressler, DPM


 


Dr. Dananberg brings up an excellent point with the experience he described. There are some very important points we can all learn from this encounter. First, and most important, is for the doctor to understand any underlying circumstances that could be involved in the patient’s life that may be causing their behavior. Understanding this can lead to a wonderful professional patient relationship that not only could last for years, but also lead to many referrals. I have had countless experiences as described by Dr. Dananberg. New patient protocol in my office involves having one of my assistants take the patient into a treatment room after they have been registered.


 


A brief history is done, followed by my assistant conferring with me before I go in the room. During our talk, my assistant will sometimes comment as to the patient’s condition, mood, or personality "quirks". This is of utmost importance because it is a signal to me that extra care or compassion is needed. I love to make patients laugh and feel comfortable. My goal is to have a patient leave the office feeling good both physically and mentally. Losing spouses or dealing with...


 


Editor's note: Dr. Ressler's extended-length post can be read here.

10/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Charles Morelli, DPM


 


Dear Mrs. _____:


 


This letter will serve as formal notice that we will no longer be able to provide foot care to you because of the following reasons: 



  • It has come to my attention that you berated a member of my staff  numerous times, after she had gone out of her way to assist you in attaining a copy of your previous MRI.


  •  After speaking with this staff member, she was both visibly and emotionally upset. She has worked here for close to 20 years and no one has ever spoken to her the way you had, especially when she was actively trying to help you attain another copy of your MRI images.


  • If you want the entire disc again, you will have to go to _______, pay $25.00 and they will be happy to give you another copy.         



It pains us to do this as we have known you for many years, but this behavior cannot be tolerated or condoned. As you have already chosen to see another practitioner to address your current condition, I will be happy to send him or her a copy of your medical records and upon receipt of your written request, I will forward a copy of those records to your new provider. As you have already attained the services of another doctor, I am under no legal obligation to continue providing you with treatment and wish you well.   


 


Charles Morelli, DPM, Mamaroneck, NY 

10/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Ivar E. Roth DPM, MPH 


 


I have found a simple way to solve this problem. When a problem occurs, I speak to both parties to get both sides and then and only then do I make a decision on how to handle the problem. I NEVER take either the patient’s word or my employee’s alone. Based on what I find out, I act accordingly. Surprisingly, it is about 50-50. My suggestion is never back the employee until you know for sure.


 


Ivar E. Roth DPM, MPH, Newport Beach, CA

10/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: If Falsely Accused - What Would You Do?


From: Martin R. Taubman, DPM, MBA


 


Friday, August 17, 2012 ended the week-long ordeal of one of the most damaging series of San Diego County fires in local history. Clouds of ash blanketed the city leaving an oily, gray residue on our cars, lawns, and streets for most of the week. People were evacuated from their homes; some homes burned to the ground. In fact, one of our fellow podiatrist’s home was lost to the fire and had to be rebuilt. People died. Lake Cuyamaca and its surroundings were devastated.


 


Driving through its prior verdant scenery was heartbreaking—the trees stood like broken, blackened skeletons amidst a barren, burned earth. The canopy of trees which covered miles of Highway 79 leading to the lake from Route 8 was gone. It was estimated it would take 100 years for the area to return to its previous pristine grandeur. I’ll never forget it.


 


However, there was another event that occurred that fateful Friday, and it will remain etched into my memory with at least the same vivid horror (or worse) as...


 


Editor's note: Dr. Taubman's extended-length post can be read here.

10/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Howard Dananberg, DPM


 



Many years ago, I had a new patient present for care. After my nurse's interview with him, she came out and said how angry and mean spirited this man was and wished me good luck. After our visit, we came out laughing and very friendly and she was shocked. It turned out that he only has a small interdigital corn, but his wife of more than 50 years who was recently deceased had exclusively cared for this.   


 


He was angry at her passing and that someone else was going to treat him. Once we both recognized the underlying cause of the anger, he turned into a long-term, wonderful patient for several years until he died. There are lots of reasons why patients are angry. Sometimes, finding the cause goes a long way towards resolving the basic issues.  


 


Howard Dananberg, DPM, Stowe, VT    


10/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Allen Jacobs, DPM 


 


Customer is defined as an individual (or organization) purchasing goods or services. When doctors became “providers,” patients became customers. The enthusiastic utilization of urgent care centers by patients illustrates the declining value of the doctor-patient relationship in exchange for service convenience. How many new patients do you see because “you were on my list of providers”? How many patients do you not see because you are no longer a provider for a particular third-party payer? How many lectures or seminars do you attend about maximization of profit from your customers/patients? People have to a large extent changed. They demand convenience, are increasingly demanding, lacking courtesy, and social graces. Egocentricity has become the new normal.


 


No, the patient/customer is not always right. I have no hesitancy to discharge patients who are abusive to staff or office policy. My charge is to provide quality care and support. Neither I nor my office exist for any other purpose. Nor should yours. You have studied too much, sacrificed too much, worked too hard, and are bound by ethical charge to be treated with other than the respect which you have earned. Conversely, to paraphrase Sir William Osler, MD, once profit and business become your priority, you have lost the spirit for which you entered healthcare. Under those circumstances, you do indeed have customers not patients. You have a business not a medical practice. As such, the customer is always right.


 


Allen Jacobs, DPM, St. Louis, MO

10/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: When a Patient Sexually Harasses An Employee


From: Elliot Udell, DPM


  


This past week, the Nassau County Podiatric Medical Association sponsored a lecture on dealing with sexual harassment issues. The main thrust of the presentation dealt with potential problems between employees and employers in the workplace as well as potential problems between workers regarding various forms of sexual harassment and discrimination. It was an excellent presentation by Mathew Feldman, JD and the Long Island team.  


 


Two years ago, one of my employees told me that one of my long-time male patients made some unacceptable verbal remarks to her of a sexual nature. There were no witnesses. My gut feeling at the time was to permanently "show the patient the door." I did let my employee know that what he said was totally unacceptable; however, since there were no witnesses, if I confronted the patient, would I not be opening myself and even my employee to a lawsuit? The patient could say in court that I falsely accused him and damaged his reputation, and since I was not there, I caused him pain and  embarrassment based on hearsay. I am certain that I am not alone and this has happened in other offices. How have others handled this problem?


 


Elliot Udell, DPM, Hicksville, NY 

10/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Keith L. Gurnick, DPM


 



About 15 years ago, I had an issue with an adult female patient, a tough and very wealthy widow and locally well-known philanthropist who dropped in to my office one day without an appointment, requesting to be seen for a non-urgent visit. When we refused her request, she then demanded her medical records and prior foot x-rays on the spot. I am sure some of the readers have encountered this same or similar challenging situation once or twice in their careers.


 


When she was told that our policy was that we needed a couple of days’ notice to make copies of her chart and physical copies of her x-rays, and that we were not able to stop whatever we were doing to comply with her non-urgent requests, she made quite a scene in front of other patients and stormed out of the office, opening the reception room door so violently that it... 


 


Editor's note: Dr. Gurnick's extended-length post can be read here.


10/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: David E Gurvis, DPM


 


I find patients are rude to the staff for several reasons. Pain and anxiety are uppermost. Fear of what the doctor might do, especially if they are fearful that it might include a needle. Having stress at their workplace for having taken off to even see a doctor. Financial reasons. And many more. I agree with what Tim Shea, DPM has said as well. And I will always try to turn a “bad” patient into a “good” patient. However, some people are just naturally rude and feel superior to those they feel are working for them. This is how they interact with the world around them and they carry it into the office.


 


The older I get, the less I find I tolerate rudeness. Life, and the day at the office, is too short for that. I don’t work for patients. I work with patients. For those who cannot be “turned,” I find discharge is appropriate.


  


David E Gurvis, DPM, Avon, IN

10/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B (Paul Kesselman, DPM)


From: Ron Freireich, DPM


 


Here is from a post of mine on this very topic over two years ago. I start out by saying, "What a crime!" In it's simplest terms, it's called fraud. When a provider commits fraud of this magnitude, they are fined and thrown out of the Medicare system for life. If you read the OIG's 45-page report, their recommendations are basically a slap on the wrist as Dr. Kesselman points out. These insurance companies are trying to make patients look sicker on paper solely for their financial gain. These audits do not benefit the patient, the physician, or the medical system in general but are a continuous burden on our practices. These insurance companies should be held accountable like anyone else that commits fraud. What advantage are these advantage plans anyway?


 


Ron Freireich, DPM, Cleveland, OH 

10/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Tim Shea, DPM


 


In the spirit of collegial discussion, I would like to point out that Dr. Udell makes some very salient (as always) points in his response to Dr. Klirsfeld's post of rude patients and staff. After almost 50 years of teaching and private practice, I must graciously disagree with some of his points.


 


Dr. Udell refers to the phrase "the customer is always right" as sort of a basis for allowing rude patients to behave inappropriately. This concept dates back to the late 19th and early 20th century and is attributable to very successful retail businessmen such as Harry Gordon of Selfridge, England, etc. There are similar phrases also seen in Germany, Japan, and other countries. They suggest that when a...


 


Editor's note: Dr. Shea's extended-length post can be read here

10/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM


 


Thank you Dr. Klirsfeld for starting a very interesting discussion. For starters, we all have to accept that many patients who come to our offices are in pain and are stressed out. People exhibit this in different ways and sometimes take it out on staff. It's important to meet with staff and let them know that unless the situation is extremely odious, approach all patients with the old adage: "the customer is always right." Sometimes just listening to a patient who is "ranting and raving" can calm things down. 


 


It is also important to determine if the staff member who is complaining about a rude patient has a "low boiling point" for patients who may have gotten up on the "wrong side of the bed" that day and may need an ounce of TLC. Such staff members may need to be trained on how to deal with difficult patients or need be have their jobs terminated. There are programs available online that can help train all of us with dealing with difficult people in trying situations. My staff and I are taking one such program right now. If anyone is interested in any of these courses, contact me personally and I will be happy to furnish you with leads. 


 


Elliot Udell, DPM, Hicksville, NY 

10/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B


From: Paul Kesselman, DPM


 


Those wonderful letters you receive from Ciox and others are at the heart of what the principal deputy inspector of the HHS OIG divulged in a recent report. These companies are attempting to game the system by corrupting the data you supply and placing patients in a higher risk level in order to obtain increased reimbursement for themselves. Their report cites that some patients were never even seen by providers yet were placed in a higher risk category.


 


UHC was one of several Part C Medicare plans which was recently fined millions of dollars. Admittedly this is small potatoes to them and still worthwhile. So your office spends time and wastes money providing this data, obtaining pre-authorization, appealing claims which should have been paid in the first place (e.g. Humana). This begs the question: Who has the "Advantage" here? The Gov't, the patient, the provider? The answer is none of the above. It is the carrier. 


 


The gov't won't withdraw carriers out of the Medicare Part C business anytime soon. So what then are the alternative penalties? How about if we start with higher financial penalties and not something akin to a $5 traffic ticket and prison sentences for those executives who are behind this corruption. More information may be found here


 


Paul Kesselman, DPM, Oceanside, NY

10/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Tim Shea, DPM


 



Unfortunately, over the past number of years, I have been seeing an increasing number of patients who act out inappropriately to staff. Having practiced for greater than 45 years, it used to be very infrequent that I would have to deal with this. Now is a different story. I don't know the reason: Entitlement? Poor social behavior habits? The reality is that this type of behavior creates a hostile environment for the office .


  


Recently, a seminar in California listed all the reasons why you can be fined for "hostile environment" by the state, and I don't know if this is one of them, but I prefer not to take the chance. So if this kind of behavior is reported by staff to me or to the office manager, out comes the well-constructed (by PICA) discharge letter of inappropriate behavior, and the patient is discharged immediately. There is no more grace period or any reason to discuss why it is unacceptable. Your staff demands your protection, and this is an example that you must set.


 


Tim Shea, DPM, Concord, CA


10/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Jack Ressler, DPM


 


There is a fine line in dealing with a rude patient. On one hand, you do have to respect the patient’s opinions. Probably more importantly, you have to go to bat for your staff if they are right. I had a very interesting experience in my office where my staff member was both right and wrong on two different occasions. The first incident occurred when a patient did not get their way when making an appointment and ended up calling my receptionist an idiot. This patient did come back to the office after apologizing. It took all of two minutes for the patient to rehash this incident and again called my receptionist an idiot. I proceeded to tell the patient to leave and never come back. This was done before treatment. I must admit, dismissing a patient like this from my practice felt great, and was the first and only time I ever did that.


 


The second occasion occurred when the same staff member left a patient who was in severe pain in the waiting room because they were early for their appointment time. This patient did confront me in private while in the treatment room. I assured the patient that I will discuss this with the staff member. Although she was wrong, I made the mistake of asking her to come into the treatment room to discuss the incident in front of the patient. She had no explanation for her reasoning. Later in private, I diplomatically explained to her why she was wrong. She obviously was not in agreement because three weeks later, she quit citing this incident as her reason. In most cases, your staff is generally going to be right and they must be defended against unruly patients.


 


Jack Ressler, DPM, Delray Beach, FL

10/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Judith Rubin, DPM


 



I have noticed that when I have been going to doctors’ offices over the past few years, I am also asked to put in a credit card that will be automatically billed for no show fees. Since we call all our patients one day before by phone and send a text, there is absolutely no reason for patients not to tell our office that they can’t make. Of course, there are certain circumstances we allow for like fever that morning, etc. It has cut down tremendously on no show patients. It even helps when patients have balances.


 


We always call and ask if they would like to use their credit cards on file or change their card. Some don’t want to give us a credit card on their paperwork. They are afraid we will bill them unnecessarily. My office manager’s comeback is “do you order things online?” Of course their answer is always “yes”. She says to them “I rest my case.” Note: There are some doctors who are only accepting cash and checks now because the rates on credit card charges are going up. 


 


Judith Rubin, DPM, Cypress, TX


10/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From:  Elliot Udell, DPM


 


I am a caregiver for my parents. This means taking them to a plethora of doctors. Many have signs saying that unless 24 hours notice of cancellation is given, there will be a charge. In my situation, between urgent care visits, doctors’ visits, and actual hospital ER and hospital admissions, we have had to miss many appointments. To date, none of the physicians we go to have "fined" us for missing appointments. If they did, we would have to choose a different doctor in the same specialty. 


 


Wearing the "shoe on the other foot", I am not thrilled when a patient does not show without notice, but we do not charge patients. We do keep a record of who tends to be a "no show" and if it is often, we will tend to "overbook" that patient knowing that there is a likelihood that the person will be a no show. 


 


Elliot Udell, DPM, Hicksville, NY

09/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Jane E. Graebner, DPM


 



One solution I have initiated in my office is creating a position called New Patient Coordinator. One of my 70+ year old employees whose only job prior to COVID-19 was visiting referral physician offices wanted to only work from home. Her duty is to call every new patient (or new problem which is someone who has been to our practice before but not recently and has a new foot/ankle problem) who are booked for one hour in our practice (1/2 hour with staff member and 1/2 hour with provider). She covers things like:


1) COVID-19 questions


2) Office location


3) Insurance coverage (to make sure we are in-network)


4) Referral source


5) Name they would like to be called


6) How they are completing their paperwork (i.e. portal, mailed, printed from website)


7) Confirming they are really a new patient (i.e. never been treated in our practice prior to this)


 


She even calls NPs after their first visit (within a week) and asks if they understand their treatment plan, etc. which gives us feedback about how we are doing. So far, this experiment has been good. Although the no show rate has not been lowered (which was my primary goal), the use of our portal has increased to 50% and the number of NPs who show up at time of appointment without any paperwork filled out has diminished as well, which helps keep us on schedule. You might want to try this for your practice.  


 


Jane E. Graebner, DPM, Delaware, OH


09/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Keith L. Gurnick, DPM


 


Some, but not all patients have little respect for doctors and your time and office space commitment to them. If you force patients to give you an upfront "scheduling" deposit on their credit card and then they do not show up, too many of them will send in a dispute to their credit card company who will almost always side in favor of the patient and refund the money you took as a deposit. Credit card companies almost always side with the cardholder. That is just the way it works, and it just isn't worth the time or trouble to do what you are suggesting.


 


If you want to charge for "no shows", then you should do it the old fashion way. Simply post your policy in your office reception room, and also include it with your new patient intake paper work and also any mailings to patients. Inform your patients in advance on the phone when they schedule, and enforce your policy by sending a reasonable bill for the "no shows" or late cancellations, and enforce your policy by collecting the money.


 


Keith L. Gurnick, DPM, Los Angeles, CA

09/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: George Jacobson, DPM


 


We have had this discussion before, but now with volunarily seeing fewer patients per hour, the "No Show" new patients make it harder to recover from this financial disaster. After being closed for 4.5 months due to the lockdown and then open-heart surgery, I began seeing patients 3 weeks ago. We have many 80 to 100-year-old at high risk patients who stayed shut in since March. We referred others and new patients to colleagues. 


 


It's like starting over again, 37 years later, but we have a small base of patients versus zero. I don't recall patients being so rude as to not show up for appointments or not calling if they...


 


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

09/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Proposed Outpatient Prospective Payment System


From: Joseph Borreggine, DPM


 


The new proposed Outpatient Prospective Payment System (OPPS) rule is out. It looks like CMS is pushing ahead with its changes in how to document and determine E&M levels (No more H+P component, Medical decision-making DM, and time only) as well as significantly increasing reimbursement for office based E&Ms. Due to budget neutrality though, this increase is offset by an across the board decrease in the conversion factor of about 11%. This is going to result in a significant decrease in fees for many procedures which will include the routine foot care codes that are used quite frequently by podiatrists. If this proposed fee scheduled is approved, then the financial impact will be catastrophic. 


 


It is my understanding that the APMA is planning to make a comment to CMS on behalf of the profession. However, they will be just one comment that will provide a global statement with respect to the negative financial consequences it will have on the profession. Moreover, every podiatrist needs to consider leaving a comment on this proposed CMS fee schedule change. 


 


The more comments that are provided from this profession to CMS on this issue, the greater the chance that CMS may reverse their decision. Here is the link to do soPlease don't neglect this. Share it with friends and colleagues. These cuts could impact every specialty. It's not just our payments that would be jeopardized. The care received by our friends and families would also be at risk.


 


Joseph Borreggine, DPM, Port Charlotte, FL
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