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03/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Knowledge Level of Nurse Practitioners 


From: Steven Finer, DPM


 


I am mostly retired, but still see patients at a local nursing home. I was approached by a nurse practitioner (NP) and asked to see a diabetic with "foot problems." The NP's knowledge ended at medications for diabetes and neuropathy. She had zero information on pressure ulcerations, off-loading, or foot structure. I explained some basics for treatment and management of this patient and she thanked me. Is this the norm for this group? Most other NPs that I have worked with seem to know heart, lungs, kidney, etc. but have no skills in Ortho. Derm, PT, or treatment of feet. 


 


Steven Finer, DPM, Philadelphia, PA

Other messages in this thread:


02/08/2023    

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



From: Robert Scott Steinberg, DPM


 


Let me respond to Dr. Amarantos, and let you decide if it's worth it to continue to be a member of Guild 45 of Lower Extremity Surgeons, OPEIU, AFL-CIO. We complain our profession is not respected by other specialists, hospitals, or insurance companies. We do get respect from OPEIU-AFL/CIO. They even lobby for our profession. Here are some of the benefits


 


HEALTHCARE BENEFITS:


 


"As you know, we, through an agreement between the OPEIU and the United Steel Workers Health and Welfare Fund, have offered members and their families fully insured health policies written through Highmark Blue Cross Blue Shield. These policies are “rich” in...


 


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

02/08/2023    

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



From: Jeffrey Kass, DPM


 


Dr. Amarantos - yes, your 100 dollars per year got you bupkis. Your affiliation with OPEIU is not the same as the teachers union here in New York or anything close to resembling a “real union”. I, too, was a member of OPEIU when NYSPMA had a similar association. I can’t recall what the benefits of OPEIU were, if any, but it’s very different than say the nurses union, teachers union, etc. The power to strike is one of the differentiating features. 


 


The ability to strike levels the playing field. Doctors will forever remain shackled until they gain this privilege. Once again, your politicians have themselves getting raises - these are the same people that can’t balance a budget and have us being stripped of money due to “sequestration”. Why isn’t their salary in “sequestration”? Doctors aren’t responsible for the budget, they are.


 


Jeffrey Kass, DPM, Forest Hills, NY

02/07/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Lecturing on New Technologies


From: Rod Tomczak, DPM, MD, EdD


 


Regarding new technologies and lecturing about them at seminars, I once heard a fellow podiatrist tell an OR nurse, "I make more money lecturing on external fixators than I would applying them all day." Enough said.


 


Rod Tomczak, DPM, MD, EdD, Columbus, OH

02/06/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Class-Action Suits Involving the Cartiva 1st MPJ “Artificial Cartilage” Implant


From: Allen Jacobs, DPM


 


There are now class-action suits involving the Cartiva 1st MPJ “artificial cartilage” implant. Lawyers are seeking clients injured or harmed as the result of this implant.


 


While I certainly empathize with those patients who will limp or forever have an altered gait as the result of the failure of the Cartiva implant, who required revision surgery, who incurred the expenses associated with this, there is another aspect of this I should like PM News readers to consider.


 


1. Anyone with experience performing foot surgery knew or suspected this implant would fail. Expecting a small piece of polyvinyl alcohol to withstand the...


 


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

02/04/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM, Josh White, DPM, CPed, Mallory Lor


 


Hopefully, you are not having your patients buy shoes online! Keep a list of patients who purchased shoes on your recommendations at your local New Balance store. Go into the NB store and talk to the manager/owner. Most stores are franchises. See what you can work out.


 


Robert Scott Steinberg, DPM, Schaumburg, IL


 


OrthoFeet offers over 150 shoe styles and is available to DPMs at wholesale prices approximately half of what the shoes sell for on our website. It also offers an Employee Discount Program.


 


Josh White, DPM, CPed, Medical Director, OrthoFeet


 


Dr. Comfort offers an exclusive employee discount for providers on shoes, socks, inserts, orthotics, and compression wear, while maintaining compliance with inducement laws. To take advantage of this discount or for pricing details, call our customer service team. We are proud to be supporting podiatry for over 20 years.


 


Mallory Lor, Dr. Comfort

02/03/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: UHC Overpayment and Appeal Letters Going Paperless


From: Paul Kesselman, DPM


 


Continuing their move to reduce costs, UHC announced today that all overpayment and appeal letters for UHC Community plans will be going paperless as of May 5, 2023 in selected markets. This announcement, while not unexpected, is actually not all bad. This actually will improve efficiency and the carrier will no longer be able to justify that they never received your appeals. Providers' ability to track receipt of appeals and decisions through the provider portal will ensure receipt and tracking through the system.


 


It's just a matter of time before digital communication with UHC will be mandatory for all plans and markets. This same process is already available with most Medicare carriers and will continue to penetrate the healthcare landscape. This is just another nail in the coffin for paper processing. It underscores the trend to digitize every healthcare transaction. Check your February 1, 2023 UHC announcement for more information.


 


Paul Kesselman, DPM, Oceanside, NY

02/01/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Proposed Legislation Would Give More Than 2 Million Federal Workers an 8.7% Pay Raise In 2024


From: Ron Freireich, DPM


 


I was shocked when I read about the proposed bill introduced in the House and Senate called the Federal Adjustment of Income Rates Act, or the FAIR Act, which would give federal workers an average 8.7% pay raise next year. I was even more shocked when I further read that this is following an executive order signed by President Biden late last year giving federal workers a 4.6% pay raise in 2023, an act that Congress chose not to override in the $1.7 trillion spending bill it passed at the end of the year. This is the same bill that waives the 4-percent statutory pay-as-you-go (PAYGO) sequester cuts scheduled for 2023 and partially reduces the physician fee schedule cuts scheduled for 2023, limiting the expected reduction in Medicare physician pay to 2 percent in 2023.


 


The cuts would increase to 3.5 percent in 2024. If you do the math, the federal workers will receive a...


 


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

01/31/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jack Ressler, DPM


 


Dr. Ribotsky brings up an interesting point. I think the onus of this decision relies on the governing credentialing board that approves the CME credits for a particular lecture. Content, validity, and the value of lecture information are far more important to me than past indiscretions of the lecturer. Obviously this must be done on a case-by-case basis. How interesting would it be to listen to a lecture given by a person who was convicted of billing and coding fraud, not for the how-to content but rather the how-not-to information provided. 


 


Maybe this is a bad analogy, but if you Google Frank Abagnale (Catch Me If You Can), he gives lectures. Here is a man who was incarcerated in three different countries and is now a very successful businessman. He is an excellent speaker and most of you will find his lectures fascinating. The real crime would be if people like Abagnale were not allowed to lecture based on past mistakes. 


 


To answer another question Dr. Ribotsky brought up in his query, I'm not sure of the importance about having to disclose if a lecturer's license has been revoked. The ironic side to that is it probably would bring more public interest to that lecture series if the status of the lecturer's license status was revealed.  


 


Jack Ressler, DPM, Boca Raton, FL

01/30/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Richard J Manolian, DPM


 


These last few days of reading about which of us are qualified for board certification and who is allowed to do certain procedures, and  what professional designation shall we go by, and the non-consensus on all of this, has given me pause.


 


Akin to the current NFL teams playing now, I liken our struggles to those teams, who if there is not A consensus among them on how to win, and if all members are not fighting for the same ultimate goals to benefit that mission, will likely lose.


 


Therefore, parity will be a long-awaited dream or goal unrealized until we stop our collective bickering and infighting and unify for our own good.


 


Richard J Manolian, DPM, Southbridge, MA

01/27/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: CMS Audits for Routine Foot Care


From: Sharon I. Monter, DPM


 


Audits for at-risk foot care are nothing new and they are simply part of doing business. While these CPT codes are certainly “on the radar screen” of CMS, they represent only a portion of what our profession contributes to the prevention of devastating and costly lower extremity complications. 


 


Many podiatrists are now recognizing that they have a much greater responsibility than just performing at-risk foot care for our patients with diabetes. The precursors for complications are often evident if we simply use tools to comprehensively explore sudomotor conditions such as the skin moisture index, temperature variations, etc., and accurately stratify the risks of our patients with diabetes. Patient-engaging care plans can then be formulated around the findings. This, along with performing at-risk foot care, makes us a true specialist that differentiates ourselves from other specialties, while also making the encounter much more profitable for the practice.  


 


Sharon I. Monter, DPM, Point Pleasant Beach, NJ

01/26/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


I find this letter troubling. "How we address the issue of multiple certifying bodies is to have the applicant provide proof that the alternate certifying body is as rigorous as the traditionally accepted organization."


 


Your process appears to have an arbitrary standard. How do you measure another board you have never applied for against "your" board? It sounds more like protectionism.


 


If your hospital's Medical Staff Office is doing the standard vetting, your department chair should have no problem understanding an applicant's experience and qualifications. Be careful if you think, "my board is better than your board," kind of stuff. Be kind!


 


Robert Scott Steinberg, DPM, Chief - Department of Podiatric Medicine and Surgery, Humboldt Park Health, Credentials Committee (Formerly Norwegian American Hospital) Chicago, IL

01/25/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: CMS Audits for Routine Foot Care


From: Lawrence Kobak, DPM, JD and James Tudor, XPX, PCA


 


Lately, we have been involved with a spate of CMS audits involving routine foot care. The chief problem the government auditors still find is a lack of proper documentation.


 


First, there is sometimes a failure to sign the chart note in a timely fashion. Secondly, the services must be medically necessary. When not diagnosing onychomycosis, the necessity is evidenced by referencing class findings. This is often misunderstood. If you are using two Class B findings, at least one of them must be for an absence of either the DP or PT pulses in the foot or feet being treated.


 


The other Class B finding may consist of any three of the...


 


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

01/24/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: American Board of Podiatric Medicine and Surgery 


From: Gerald Peterson, DPM


 


Here’s an idea: Since all residencies are now three years and certified by CPME, the graduates from these programs become board eligible immediately on completion of their residencies. They then have 7-10 years to gather their cases to submit to sit for the exam. I suggest that the Young Members Association be consulted as they are the ones in the trenches and know most realistically what time frame is accurate to achieve those case levels. 


 


The exam should be written by colleagues from ALL genres of podiatric medicine to ensure a broad spectrum of competence in podiatric medicine and surgery. Candidates would have only a set opportunities to pass the exam before no longer being eligible to be certified. Re-certification would occur every set number of years by exam. Finally, a pathway would be written to allow ALL podiatric physicians access to board certification. It may not be an easy pathway and may be almost impossible for some, but it still would provide a pathway that is reliable and ensures safety of the public while still guaranteeing competence.


 


This is just one man’s solution to this seemingly unsolvable problem that has gone on for years with no foreseeable solution. 


 


Gerald Peterson, DPM, West Lynn, OR

01/20/2023    

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



From: William P Scherer, DPM, MS


 



I inputed to ChatGPT "Question - is podiatry a rewarding career?"


 


Response: "Podiatry can be a rewarding career for those interested in helping people with foot and ankle conditions. Podiatrists, also known as doctors of podiatric medicine (DPMs), are medical professionals who diagnose and treat conditions affecting the foot, ankle, and lower leg. They provide a wide range of services, from prescribing medication and performing minor surgeries to providing orthotic devices and other treatments.


 


Podiatry can be rewarding as it can help people to improve their mobility, reduce pain, and maintain an active lifestyle. Additionally, podiatrists can work in different settings, such as private practices, hospitals, long-term care facilities, and research institutions. They also have the opportunity to work with a diverse patient population, including children, athletes, and older adults.


 


On the other hand, the field of podiatry can also be demanding, with long hours, a high volume of patients, and the need to keep up with the latest research and technologies. Additionally, the field of podiatry can be competitive, with a limited number of positions available in certain areas.


 


In general, if you have a passion for helping people and an interest in the anatomy and physiology of the foot and ankle, and you have the ability to work well under pressure and are willing to put in the time and effort required to become a podiatrist, it can be a rewarding and fulfilling career."


 


William P Scherer, DPM, MS, Delray Beach, FL


01/20/2023    

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



From: Jack Ressler, DPM


 


I was recently introduced to ChatGPT by a friend of mine. It is one of the new online search engines that uses AI (artificial intelligence) to provide some amazing results. I have spoken to some people in the investment field and they say ChatGPT is actually making Google nervous! And one of the people behind this company is none other than Elon Musk. What a surprise.


 


Jack Ressler, DPM, Delray Beach, FL

12/07/2022    

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



From: John Moglia, DPM


 



My office policy is that after 2 missed appointments, the patient is sent a friendly note stating that if a 3rd appointment is missed, a fee of $25 will be charged. A patient who missed her third appointment was sent a bill. She attached a note with her check payment that "you could have spent your free time doing paperwork."


 


I returned her check with my personal note attached, "I need your respect for my time more than I need your check." I would have returned her check anyway if there had been a note of apology. Gladly, she has not attempted a 4th appointment. 


 


John Moglia, DPM, Berkeley Heights, NJ


12/07/2022    

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



From: Steven Selby Blanken, DPM


 


I disagree with a recent opinion from a respected DPM who has been retired for many years. Things are way different now with the increases in costs to run a practice, as well as the improvements we can use to remind patients about their visits. Yes, most successful practitioners do charge for no shows, especially without notice. It doesn’t take much to send a reply when you get a reminder call, email, and even a text message (let alone, the appointment card given to patients as they leave a visit). Interesting, most will find that most “no shows are from Medicaid patients. On a separate note, most of us who treat people with mental disabilities have a power of attorney/or responsible family member, or even a paid caregiver who has been designated to be responsible for the next appointment. Of course, if they were sick or” if something bad happened, yes, we waive the fee for that person.


 


We also have a 3 strikes rule and you are out. We also increase our charge if you have missed more than one visit. It is hard to practice when you average 3-6 no shows a clinic day. Costs are rising and insurance companies are rejecting more and more reasonable modifier -59 charges that you have to appeal, win, then appeal again when you see the patient again. So, I am sorry but this is the world now. You need to charge for these “no shows” to stay afloat.


 


Steven Selby Blanken, DPM, Silver Spring, MD

12/06/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Charging for Missed Appointments


From: Joel Lang, DPM


 


There has been a lot of chatter about charging for missed appointments. Though now retired, I did practice for 35 years. Over that time, I came to some realizations. An important one was that I was not the center of the universe in the patient’s life. I was only one event in their week among many events.


 


Patients miss appointments for too many reasons to list, but some are weather, car trouble, forgetfulness, family emergencies, illness, and let’s not forget those who do not fully control their own lives, like mothers, those with mental illness, and those who depend on others for transportation. Charging for a broken appointment may be adding insult to injury in their life experiences; that is certainly not...


 


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

12/02/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: "A Survey Analysis of Patient Understanding and Preferences for Podiatrists Versus Foot and Ankle Orthopaedic Surgeons"


From: Allen Jacobs, DPM


 


PM News readers would be well advised to review this recent article published in the journal Foot & Ankle Specialist. The article is yet another in a series of willful, malicious attacks on our profession. This article, like similarly themed articles previously published by our orthopedic colleagues, is complete with inaccuracies, poorly performed statistical analysis, and false conclusions.


 


The references are not consistent with the authors' intention to besmirch podiatry and are not included. Shockingly, a podiatrist affixed his name as a co-author!


 


Allen Jacobs, DPM, St. Louis, MO

11/28/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Politics and Healthcare


From: W. David Herbert DPM, JD 


 


I attended law school in Sacramento, California in the 1980s. My law school offered an elective course which allowed us to work with an attorney who was a lobbyist. One of the students in my class was an optometrist who was working with the optometrists' lobbyist. There was not an attorney lobbyist representing podiatry in the state legislature at that time. I decided to work with the attorney lobbyist representing the chiropractors. One of the issues at that time was whether a chiropractor could order an MRI at a hospital. Organized medicine was very much against this and and a former president of the California Medical Association (who was a retired radiologist) was flown up from Los Angeles to testify against it.


 


The assembly committee on health had a member who was also an optometrist and very much in support of the chiropractors' Bill. By being prepped by both the chiropractors and optometrists  lobbyists, he was able to effectively question the retired radiologist when he was testifying. Eventually, the Bill was passed and signed by the governor. Remember, even if you do not like politics, politics affects you personally and professionally every day!


 


W. David Herbert DPM, JD, Billings, MT

11/25/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jeffrey Kass, DPM


 


I agree with Dr. Herbert’s opinion. If things aren’t changing, it would behoove someone to change strategy or legal representation. One would think that new legal counsel would be hungry to show their worth. Most other professions are advancing their legal scopes and our profession remains pretty stagnant in comparison. I notice most of the doctors in my state who increase their scope are the ones that leave the state. But, yet the state societies keep the same lobbyists and attorneys. Makes one wonder. 


 


Jeffrey Kass, DPM, Forest Hills, NY

11/24/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Overcoming the Influence of the AMA


From: W. David Herbert, DPM, JD,


 


In 1967, the AMA declared that it was unethical for an MD to refer patients to chiropractors, but today chiropractors can obtain privileges on hospital staffs to perform spinal manipulation under anesthesia. A half dozen states allow psychologists to prescribe psychotropic drugs and at least one allows optometrists to perform lasix surgery. We know that a number of states allow nurse practitioners to practice independently.


 


Obviously, the influence of the AMA to block legislation by other professions trying to enlarge their area of practice is not what it used to be. Maybe podiatric leaders should hire some of the same lobbyists the chiropractors, optometrists, and the nurses use!


 


W. David Herbert, DPM, JD, Billings, MT

11/23/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Morton I. Altman, DPM, Philip Radovic, DPM


 


As a retired podiatrist, residency director, and researcher, I am no longer surprised at what level pharmaceutical companies, medical supply manufacturers, and others will go to sell the public on their product. Sad what has happened.


 


Morton I. Altman, DPM, Gig Harbor, WA


 


I recently promoted one of these Lapidus systems and decided to stop as I share the same frustration as Dr. Oloff. Are aggressive marketing strategies and doing an end run directly to consumers improper? It’s what pharmaceutical companies began some 20 plus years ago when they successfully lobbied congress to allow advertising medications directly to consumers when it was considered taboo…much like advertising tobacco is not allowed today. Although some of these systems have inventive clamps and guides, their function is easily reproducible with conventional instrumentation. One can argue the benefit of informing the public in a general sense; however, the cost and complexity of these systems, in my opinion, are unnecessary.


 


Philip Radovic, DPM, San Clemente, CA

11/22/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: The Commercialization of Medicine


From: Lawrence Oloff, DPM


 


I would like to share my frustrations with the commercialization of medicine. I grew up in an era of medicine where surgical equipment companies would introduce doctors to their newest gizmo via reps and meetings. Some of these were true advancements, and other not. Doctors would attend labs, listen to experts, and would then incorporate new devices/implants into their practice that they felt had merit. We have now entered an era where companies target the consumer.


 


In essence, a backdoor approach to the doctor. Promises of better results and faster recoveries have flooded the marketplace via the Internet, and...


 


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

11/21/2022    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: The Power of Your Patients and the Media


From: Paul Kesselman, DPM


 


The power of the media and your patients working together can reverse payment denials. A suburban Chicago area resident recently went on TikTok in order to obtain a reversal of a $40K payment denial for kidney tumor surgery. This, even though the hospital and physician had obtained pre-authorization from Anthem. This recent story shows the power that you and your patients along with the media can leverage over these giant monopolies.


 


One cannot expect to generate much empathy over small denials typically seen in many physicians’ offices. However, lumped together, a union or group of patients filing a similar action against an insurance giant may be able to leverage equivalent results. 


 


Paul Kesselman, DPM, Oceanside, NY
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