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RE: Podiatrists and COVID-19 Pandemic

From: Janet Kail, DPM


Has anyone addressed whether it is advisable to continue seeing non-emergent patients in our offices?  So far we are still seeing patients but for the health and safety of all (doctors, staff and patients), what is the opinion of everyone about keeping our private offices open during the COVID-19 crisis)?


Janet Kail, DPM, Fairborn, OH

Other messages in this thread:



From: George F. Jacobson, DPM


I had open heart surgery on June 18 and was home on Monday. Everybody on my floor was required to wear a mask. I posed the same question whether it's slowing down recovery. Getting out of bed and walking was more difficult wearing a mask. Talking was more difficult wearing a mask. I mentioned the same issue to one of the cardiac nurses and was told that an ER nurse was sent home with CO2 difficulties and hasn't returned. I ordered an oximeter. 


George F. Jacobson, DPM, Hollywood, FL



From: Michelle Sparks, DPM


I have found terrific resources for re-opening practices on the APMA site. There’s a tab on the COVID-19 page called Re-opening Your Practice. Not only are there checklists, but a podcast with members who have reopened, webinars, and links to information about what’s going on in individual states. There’s also a clickable infographic that breaks out lots of advice. I would strongly encourage members (and nonmembers—the materials are open to all podiatrists) to look at the information out there. As an owner of a private practice dealing with all of this, the guidelines there have been helpful during this transition to a “normal” schedule.


Michelle Sparks, DPM, Kittanning PA



From: David E Gurvis, DPM


I have a straightforward answer. I practice medicine. I try to practice safely in all aspects. Please wear a mask, and wear it safely. There is no discussion. If they ask, then on a non-political basis, I simply remind them the pandemic is not over and those choosing to go without a mask do so at their own, and that of the family and neighbors, friends and co-workers, risk of illness and potential death. So far, all have complied. Not all happily. The mask below the nose to prevent fogging gets a lecture, albeit a humorous one, still a lecture. When someone arrives who declines to wear a mask, and it will happen, we will point the door to them and direct them to leave.


I am 71, still having fun, want to see my grandkids grow up and marry. Some, “You’re violating my civil rights” or “Last I knew, I was a free American.” Some doofus isn’t going to mess that up for me, my staff, or my family. When asked specifically about some rallies, or some political protest, I reply that "We Don’t Do Politics in the office. 


David E Gurvis, DPM, Avon, IN



Paul Busman DPM, RN


I'm not in practice any longer but if I were I’d say, "As a physician, I was trained to follow the most up to date scientific evidence-based research in choosing office policies and practices that can best protect you, my patient, as well as my staff, myself and my family. Thank you for your understanding". I would even try to pre-empt the question by posting signs to that effect on the front door, in the waiting room, in treatment rooms, and at the front desk.


Paul Busman DPM, RN, Frederick, MD



From: Lee Rogers, DPM


The American Academy of Family Practice has a useful preparedness checklist for physician offices during the COVID-19 pandemic. 


Lee Rogers, DPM, Las Vegas, NV



From: Larry Schuster, DPM


My waiting room used to be a major social gathering place as patients would enjoy seeing friends and relatives every few months before or after their visits. I have seen offices where they placed tape over every other chair to allow for some social distancing. Of course, chairs would have to be cleaned before and after each seating as we do in our treatment rooms. 


Note: Magazines have since been removed


My simple solution is pictured above, anti-social, simple but effective. We take each patient directly to a treatment room. Fortunately, we have 5. Scheduling is very carefully done and no patient actually comes in contact with another. Everyone is masked and universal precautions have always been followed. 


Larry Schuster, DPM, Parsippany, NJ



RE: SBA and Treasury Announce New PPP EZ Forgiveness Application

From: Neal Houslanger, DPM


The U.S. Small Business Administration, in consultation with the U.S. Department of the Treasury, posted a revised, user-friendly Paycheck Protection Program loan forgiveness application implementing the PPP Flexibility Act of 2020. In addition to revising the full forgiveness application, the SBA also published a new “EZ” version of the forgiveness application applying to borrowers who:

  • Are self-employed and have no employees; OR

  • Did not reduce the salaries or wages of their employees by more than 25%, and did not reduce the number or hours of their employees; OR

  • Experienced reductions in business activity as a result of health directives related to COVID-19 and did not reduce the salaries or wages of their employees by more than 25%.

Neal Houslanger, DPM, Patchogue, NY



From: Keith L. Gurnick, DPM


Over the years, I have heard many adages from my patients. But the conventional wisdom I have heard repetitively from my patients who owned boats, and also those who owned professional sports teams, remains uniquely the same: "The two best days of my life was the day I bought,  and then the day I sold..."  


Keith L. Gurnick, DPM, Los Angeles, CA



RE: Risk of DVT, VTE, and Post-Operative Thrombosis on Patients with COVID-19 History

From: Michael M. Rosenblatt, DPM


It is well known that patients who have an active infection are at far greater risk from DVT, VTE, and post-operative thrombosis. I think that podiatrists are very much aware of this issue and routinely prescribe lower-extremity rhythmical compression devices post-operatively for many podiatry surgery patients, especially if they will be bed-ridden for over 24 hours. But there is also a concern for female patients who use tobacco and have exogenous female hormone therapy in active use, as well as obesity.


My concern is that apparently COVID-19 patients also have a similar risk, EVEN after they recover from the active infection. We do not know yet how...


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



RE: Kudos to APMA

From: Timothy P. Shea, DPM


Thank you Dr. Rubenstein, and staff of APMA for assisting members who have not received any funds from the HHS stimulus in the first round and now are excluded from any funds in the second round of stimulus money. As one of those practicing podiatrists who has remained open and retained staff during this COVID-19 crisis, and clearly is eligible for funding, I have gone through the gamut, trying to rectify this oversight. 


The APMA through its directors and legal staff have assisted me in this effort. Unfortunately, the process by which the program was set up means there is no way to find out why you may have been denied. This is true even if you make it through the hotline process and it is clear you should be eligible. They cannot rectify it as they do not have the authority to distribute funds or change status. It is a Catch-22 at the highest level.


I am hopeful that HHS will take a hard look at the letter APMA has sent them, and also at eradicating the inequality of the current scenario. Thank you again APMA. It is another reason why all practicing podiatrists need to join.


Timothy P. Shea, DPM, Concord, CA



From: Michael McCormick, DPM


If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional General Distribution payments.


Michael McCormick, DPM, Venice Gardens, FL



From Ron Werter, DPM


It’s great that you continued to pay your employees for not coming to work. I did that for a few weeks, but then we both realized that they would make more money by going on enhanced unemployment. Do your employees realize that they are losing money by your continuing to pay them? 


The upside is that you can have them come back to work immediately when you re-open, whereas I have to negotiate with my employees because the enhanced unemployment ends on July 31 (Unless, of course, reduced hours will still allow them to collect the extra money). 


Ron Werter, DPM, NY, NY



From: Bruce Pinker, DPM


While I watched the full video of Louis Rossman as he ranted about various topics, there is an important point that is being missed. Continuing to pay your employees during the pandemic, even when your business may have closed its doors, goes much further than buying employee loyalty. Some, if not all, of your employees may have families to take care of and mouths to feed at home. They are human beings. They need to be able to provide for their families.  


These are the reasons why we decided to continue to pay our employees during the pandemic while our doors were closed and we were not treating patients, regardless of PPP funding. 80% of our employees at our practice have families to provide for, and they are all valuable employees. They are like family to me. We care about our employees. Showing your employees that you care about them will build loyalty and a strong culture. Money cannot buy it.


Bruce Pinker, DPM, White Plains/Nanuet, NY



From : Larry S Goldstein, DPM


This in response to the posting telling us that you are required to fill out a secondary application called the Disaster Loan Assistance through the SBA. I called the SBA and confirmed not only is there not a second application to fill out in order to qualify for loan forgiveness, but this application is only for those in the agriculture business. 


If you received a PPP loan/Grant, the only requirement at this moment is to attest to receiving the monies. In a few months, the SBA will be sending out info to loan recipients to verify use of the monies to determine loan vs. grant. 


Larry S Goldstein, DPM, Warner Robins, GA



RE: Socially Spacing Patient Appointments

From: Keith L. Gurnick, DPM


Even during what we used to refer to as "normal" times, the issues of patient scheduling and office flow have always been challenging. As doctors, one of the biggest patient complaints we try to mitigate, come from patients who arrive on time for their appointment and then have to wait to be seen by their doctor. The end result of the coronavirus pandemic is that patients may be seen more "on time" when they arrive to the doctor’s offices but they may have to wait longer to get that appointment. Either way, patients will not like this and will complain and become frustrated with their doctors and the healthcare system.


Socially spacing patient office appointments means reducing or limiting patient scheduling to allow more time in between patients by reducing office patient traffic and congestion. This is being done for health and safety purposes and to allow more time to...


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



RE: Pandemic Seen Decimating Physician Workforce as At-risk Older Doctors Cash Out 

From: Leonard A. Levy, DPM, MPH


Dozens of physicians, practice managers, and medical society executives around the country said that among older doctors still practicing -- 120,000 of whom were 65 or older in 2017 talk of an earlier-than-planned retirement is getting louder in the eye of the COVID-19 pandemic, according to a June 3, 2020 report in MedPage Today (Cheryl Clark). Among the influential factors is analysts' projections of a looming major decrease in commercial coverage, according to the national consulting firm Health Management Associates. Another major impact on the older physician is the health risk they and their families face should they become infected.


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL



RE: Loyalty and the Coronavirus Pandemic

From: Dieter J Fellner, DPM


In these troubled days, so many podiatry (and other) businesses let go of their staff, sometimes with indecent haste. I want to share the business and life philosophy of one of NYCs' young entrepreneurs, Louis Rossman. He is in the electronic repair business. And here is what he has to say about it:


"People said I'm a good employer - I am telling you I am not. I paid all of my staff who chose to stay home, even before I got PPP stuff. If you were one of those full time people, and you chose to stay home during that time period, I paid it in full. That was BEFORE the PPP loan went through; before I even knew there was a PPP thing. That is not because I am a kind, benevolent, and good-hearted man. That is because...


Editor's note: Dr. Fellner's extended-length letter can be read here. Louis Rossman's complete YouTube video can be viewed here. The referenced text starts at about 14 minutes. Note: This video contains some course language.



From: Connie Lee Bills, DPM Richard D Wolff, DPM


Yes, I received my second disbursement. It was about half of the previous payment.


Connie Lee Bills, DPM, Mount Pleasant, MI


I applied for part 2 on 4/28 and received an email indicating that it would take about 10 business days to process. Last week, (5/30) I called the Provider Relief Fund Hotline (866-569-3522). They were able to verify that my documents had been properly submitted. They said that payments were taking longer than expected and I likely would receive it this week. They also said paper checks are produced on Wednesdays and direct deposits are done on Fridays. I am waiting to see if we get the deposit tomorrow.


Richard D Wolff, DPM, Oregon, OH



RE: PPP Payroll Forgiveness Application

From: Richard A. Simmons, DPM


For those who received money from the PPP/SBA loan program, this is a secondary form we have to fill out in order to be forgiven for the loan(s).


Richard A. Simmons, DPM, Rockledge, FL



RE: AAD COVID-19 Registry

From: Seth A. Rubenstein, DPM


APMA is working closely with the American Academy of Dermatology (AAD) on its established COVID-19 registry. APMA encourages its members to report cases of lesions on the feet associated with COVID-19 through this registry, which is HIPAA-compliant and has undergone Institutional Review Board (IRB) approval.


The emergence of so-called COVID Toes is an opportunity for our profession to both contribute meaningful data as well as assist with research, publish papers, and collaborate with another medical specialty in education and research opportunities. Developing peer to peer relationships with the house of medicine can also open other doors for advocacy and education. The Principal Investigator of the AAD Registry, Esther Freeman, MD, PhD, shares, “we have seen a broad range of cutaneous manifestations in COVID-19, many of which involve the extremities and acral surfaces. We look forward to collaborating with our colleagues from the APMA."


APMA requests that you support the AAD COVID-19 Registry as it could have both immediate and long-term strategic benefits for our profession. 


Seth A. Rubenstein, DPM, President, APMA



From: Harry L. Penny, DPM


I want to thank Dr. Steven Kravitz for an informative post. There’s no doubt that wound care helped stabilize my practice and those of many others during the current COVID-19 crisis. Every podiatrist may not choose wound care because of frequent emergencies and the complexity of care due to many patients’ co-morbidities. I find wound care to be extremely satisfying. It is demanding, but very rewarding as the techniques and treatment help patients keep their lower extremities and enhances their quality of life. Wound care allows podiatry to be an integral part of mainstream medicine in a manner that is unique.


It is valuable for podiatric physicians who might want to add wound care to their practices to join a wound care organization. A wound care organization such as the Academy of Physicians in Wound Healing (APWH) is essential for education and networking opportunities. Certification in wound care provides an additional level of competency. APWH recognizes the Council for Medical Education and Testing (CMET) whose certification process provides equal certification to allopathic and podiatric physicians. 


I personally would recommend the APWH because it is the only physician oriented wound care organization in the U.S. The educational programs are among the best in the country and the 2020 Annual (Virtual) Conference will be free for members and this year.  


Harry L. Penny, DPM, Altoona, PA



RE: Can providing wound healing increase podiatry practice stability during the COVID 19 pandemic?

From: Steven Kravitz, DPM


During the past six weeks, I have had the opportunity to speak with many podiatrists representing private practice and wound healing center physician staff. I’ve also reviewed the responses from two APWH membership questionnaires and moderated two APWH webinar- type teleconferences. The best summary can be found in the following statements from selected conference call participants. The responses represent the overall consensus from a broad geographic area.


New York City, Philadelphia, and similar areas have been heavily affected by COVID-19. Many physicians find themselves unemployed as medical centers and wound healing centers have closed. Yet even in these areas, podiatrists seeing wound care patients seem to be better off than...


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



From: Donald Blum, DPM


I would refer patients to the emergency department of a hospital with capabilities of treating COVID-19. The Covid toe "syndrome" is a symptom of the disease and the disease needs treatment and of course proper diagnosis including testing for COVID-19.


Donald Blum, DPM, JD, Dallas, TX



RE: Should DPMs Charge a PPE Fee?

From: Bret Ribotsky, DPM


As I watch my colleagues begin to open in post-COVID times, I wonder if anyone is charging a PPE fee to patients? I see that the dental profession is charging a “fee” for all the extra costs needed to provide care. I have read statements on the American Dental Association (ADA) webpage that show a collective action to charge for these extra costs. 


I see that this topic is not (yet) covered on the APMA COVID webpage. While the profits (margins) have continued to decrease to the podiatric physician, I worry how this added cost (if not passed through) can be absorbed at the current reimbursement rates. I recognize that the logistics (insurance contracts, etc.) need to be worked through, but we all know that in a crisis, there is always an opportunity.  


Bret Ribotsky, DPM, Boca Raton, FL



From: Jackson M. Lim, DPM


I applied for the CARES Paycheck Protection Program through my long time Chase Bank in the first round. Applied in the first hour, the application portal opened only to be shut down later due to closure of the application process (i.e., no more money available). I checked around my local small banks to find out applications are closed also. One of my colleague's application was accepted and processed but he never received the funds.  


I tried again in the second round of stimulus availability - no luck either. Meanwhile, I kept my small staff on payroll during this whole period. I received an email from Square who we use for credit card payment processing that they were taking applications for the PPP. This was last week and I decided to apply on Tuesday, April 28. I received an email the next day that my application was verified by Square Capital and approved to be forwarded to SBA. By Friday, I received an email that SBA approved the loan. I just checked by bank account and see the loan was deposited. It took less than a week. 


I had given up until I received the email last week from Square. Give Square a try. You need to open an account for the loan process but it does not require you to process your payments through them. There is still some hope for PPP loans for us in private practice. 


Jackson M. Lim, DPM, Yuba City, CA

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