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RE: Insurance Companies and Credit Cards

From: Gary M. Mantell, MS, DPM


It seems as though many insurance companies have resorted to mailing or faxing one-time credit card payments. As it is, we are seeing drastic cuts in reimbursements. Now with these paper credit cards, we are losing an additional 2 or 3% in processing fees. As these payments arrive in our office, we are contacting the issuer to instead provide us with a paper check or direct deposit of the amount due.  


Just when it seemed like we had solved the problem, one payer (Zelis) informed us that there would be a 1.9% charge to issue direct deposits! How in the world can this be possible? I realize there is the notion of "the cost of doing business" and wonder if my colleagues simply absorb these costs and just move on, somehow pass the fees on to patients, or have found a way to outsmart the insurance company.


Gary M. Mantell, MS, DPM, Memphis, TN

Other messages in this thread:



From: Daniel Waldman, DPM


Over the past few years, I have also received more and more faxes from pharmacies (CVS accounts for probably over 90% of these faxes) stating that a patient expects to pick up the refill in a couple of days. When my staff calls the patient, they have no idea why this was sent as they have not requested the refill. I’ve called the pharmacists directly and they admit that the patient did not request a refill but the higher-ups at corporate management are instructing the refill request to be sent to physicians. When I asked the pharmacists why this is happening, they have flat out told me it’s all about corporate profits and they cannot do anything to change the system. The pharmacists seem genuinely interested in providing the best care but they are simply cogs in the machine of the corporations.


I wonder how many physicians simply sign off on these refill requests and patients are continuing to take medication that they no longer need. I have worked with a couple of law firms around the country about unsolicited/unauthorized faxes. A few years ago, I settled out of court with a company for a five-figure payout. This was not a pharmacy. Although class action lawsuits can be effective, they take many years and plaintiff awards are capped. The law firms make the majority of the payouts. Perhaps it’s time for congressional hearings?


Daniel Waldman, DPM, Asheville, NC 



From: Brian Kiel, DPM


I don’t disagree with Dr. Ressler as to ON shoes being the hot fashion shoe but to call it or to refer to it as a running shoe is completely wrong. New Balance, Brooks, ASICS, and Saucony are running/walking shoes. These companies are using  technology to determine what needs to go into their products. ON uses eyes to determine theirs.


Our job is to guide our patients, and honestly my patients seem to appreciate and follow my recommendations as to the correct brand of shoes. ON shoes are fine to wear to the movies (whenever that is) but not as a replacement for proper athletic shoes.


Brian Kiel, DPM, Memphis, TN



RE: ON Running Shoes

From: Jack Ressler, DPM


As podiatrists, we are always trying to recommend the best supporting athletic shoes to our patients. On several occasions it becomes very frustrating treating patients only to deal with their non-compliance due to "heavy or ugly" shoes. As an alternative, I have been researching "ON" running and athletic shoes quite extensively and have found several models to provide good support while checking the boxes of providing support and pleasing aesthetics. 


My philosophy has always been to get patients to purchase shoes that they will wear as opposed to them continuing to wear their Keds and other brands just because they feel good. Let's face it, getting them to wear Brooks Beast or Ariel, New Balance 1540 and others is not always an easy sell. As most of you know, ON shoes are setting the fashion world on...


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



RE: In-Person Conferences and the Omicron Variant

From: Jeffrey Kass, DPM,


Medical necessity are words podiatrists grapple with on a regular basis. Recently, three New York podiatrists (Drs. Chaskin, Jaffe, Udell) discussed whether NYSPMA should livestream their 2022 Clinical conference in order to reasonably accommodate those immunocompromised or at high risk the opportunity to participate. Dr. Jaffe informed us that he would not attend. With the recent outbreak of the omicron variant, and New York State under a state of emergency, is an in-person conference medically necessary and prudent? Why take unnecessary risks of potentially causing colleagues to possibly get ill or transmit the virus to others? 


This past weekend, I participated in Desert Foot’s online conference. Anyone who attended can verify that one can learn from an online conference as much as from an in-person conference.


Jeffrey Kass, DPM, Forest Hills, NY



From: Robert D Teitelbaum, DPM


On August 26th, PM News published my post on the disappearance of a nutraceutical - N acetyl cysteine - from the Amazon retail site. N acetyl cysteine is used by cystic fibrosis and covid patients as a preventative for respiratory symptoms. It is also mentioned by Peter McCullogh, MD, an expert in the treatment of COVID-19, and by the FLCCC, which is the "Frontline Covid Critical Care" alliance as part of the 'neutraceutical mix', along with zinc, selenium, etc., where research has shown they are useful in blunting the effect of the virus. It is still missing from Amazon. Look-a-likes, sound-a-likes abound on every site, but no "NAC".


It is not toxic, habit forming, nor effects blood clotting, etc. It may be no better nor worse than many other supplements. But we, the public, are being 'protected' from purchasing it. An additional note: I saw my internist in September and related this story to her. She surprisingly said, "Oh, they're using a lot of that in the hospital." We both did not have time to pursue what was a "You're kidding me!" moment. So, for the last 5 months, NAC has been unavailable on Amazon (thank G-d for ebay), but the hospitals are using it for the treatment of COVID-19? Is there someone out there who can explain this without expressing a political narrative?


Robert D Teitelbaum, DPM, Naples, FL



From: Vincent Marino, DPM


My reply to Dr. Udell’s query is, “It depends on your location.” My office is in San Francisco, which has a younger aged patient population who are computer and mobile phone savvy. The City has a significant number of patients scheduling their initial office visits utilizing ZocDoc. It goes with the age 20-40 populations in a city environment being tech savvy. However, it does not work in my Novato (suburban) location and hence we don’t use it for this office location; it is more of a bedroom community and has a higher population of seniors. I can say that it has paid for itself in the SF office and is worth it in that type of environment.


Vincent Marino, DPM, Novato/San Francisco, CA



From: Robert S Steinberg, DPM


I find ETF far easier in my practice. Payer sites have shortcuts in our browser. Printing an EOB takes a minute or two. While EOBs are printing, the staff is doing other things. Payments via direct deposit take less time. Lost in the mail does not happen.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Ron Werter DPM


I’m sure that Dr. Kesselman would agree with me; my heart bleeds for those insurance companies. 


I noticed that with many of the companies using EFT payments, we have to go online to access the EOB. When a paper check was sent, the EOB was usually included. So while it may take more time for my office to process a paper check than an EFT, it takes much more time to go to the payer site and download or print the EOB so I know what the payment was for.


Ron Werter, DPM, NY, NY



RE: Inflation and Podiatry

From: Jeffrey Kass, DPM


I received an email today from a podiatric purchasing group advertising boxes of gloves on sale 30 percent off. Sale price of $13.49 per box of 100 (nitrile). I remember when I started practicing, I was paying under $3 for a box of 100. I realize COVID-19 has caused the price of gloves to skyrocket but I also realize that over the same period, insurance reimbursement has continued to go down.


It doesn’t take a brain surgeon to figure out this model is not sustainable. I used gloves as the example, but prices of lidocaine, dexamethasone, and dehydrated alcohol are also rising faster than the speed of light. Minimum wage keeps increasing, malpractice rates go up….. how the heck do new graduates pay back student loans? 


Jeffrey Kass, DPM, Forest Hills, NY



From: Judd Davis, DPM


We refuse to take those virtual credit card payments. That 2-4% loss adds up to a chunk of change at the end of the year. We made the mistake of taking a couple of small ones and suddenly got a whole bunch of payments sent to us that way. Simply call the company that issues the payment, (i.e. Zelis) and tell them you want a paper check and will not accept any more virtual credit card payments. That fixed it for us, with no additional charges for getting a paper check.


Judd Davis, DPM, Colorado Springs, CO



From: Jack Ressler, DPM


I have been debriding hypertrophic toenails for many years utilizing sharp curved nail forceps. Although I consider myself very proficient doing this procedure, there is no way the patients' nails would be smooth enough to leave my office. A majority of my routine care patients are diabetics, have poor circulation, or are on blood thinners. These patients run a much higher risk of complications due to "sharp" nails that were not filed. A simple scratch causing a break in the skin on the opposing leg while sleeping isn't uncommon among the elderly. 


Left untreated, an open wound, especially in a vascular compromised patient, could be devastating. How about a patient "catching" their sharp nail(s) while putting on socks, causing a partial avulsion? Try building up a successful routine care practice of insurance and self-paying patients sending them home with toenails not filed; a great practice builder for the podiatrist down the street from you.


I respect Dr. Albright as being a well-trained podiatrist. I understand the opinion of colleagues coming out of a three-year surgically residency, not wanting to deride and "file" nails. If you choose to do that basic procedure, you owe it to your patients to do it correctly or send them to another podiatrist. 


Jack Ressler, DPM, Delray Beach, FL



From: Steven Finer, DPM


Given that formaldehyde is a known carcinogenic product, it is very effective as a drying agent for mosaic type warts. A pharmacist can make up a 10% solution to be used as a soak. 


Steven Finer, DPM, Philadelphia, PA



From: Jack Ressler, DPM


I have purchased new MTI and Midmark chairs. Both are very good but Midmark is the best. I also purchased a used Midmark 417 chair and must say that it is still giving me maintenance-free operation. A good rule of thumb would be to purchase a good used, top brand chair. If you look at Midmark, DO NOT purchase an hydraulic model. There are still some out there but the maintenance is very costly, not to mention difficulty in getting parts. Stay away from other models.


Again, there are several available at good prices but in the long run, you will be dumping hard earned money into a poor functioning chair. If purchasing used equipment, try to deal with a company with a good reputation. Remember, as the saying goes, "you get what you pay for." 


Jack Ressler, DPM, Delray Beach, FL



From: Charles Morelli, DPM


As no one else has commented, I guess it is I who has a problem with this ad. It is yet one more thing that I shake my head at as to how our profession is portrayed in the media.


Here we have a podiatrist (an actor) who is not only examining a patient’s foot and he still has his socks on, but then quips “have you read any good books lately?" I would have preferred the doctor/patient interaction to have been different as this could have been done so much better. 


Charles Morelli, DPM, Mamaroneck, NY



From: W. David Herbert, DPM, JD


Over two hundred years ago, Thomas Jefferson predicted that judges would become little dictators. If we are talking about the standard of care in a medical malpractice case, one of these little dictators will be the one who will be in charge of who will be allowed to testify regarding the standard of care in any malpractice case. In some states, a non-doctor can testify about the standard of care of a doctor.


You also must remember that becoming a judge really depends on your politics and has nothing to do with your knowledge of science or medicine. Just something to consider when discussing standard of care.


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



From: Dennis Shavelson, DPM, CPed


Resistance Training (RT) is one area where there has been a dirth of reviewable evidence for the “Standard of Care” (SOC) for decades. This has led to the ability of those producing and marketing their equipment and methodology to claim “SOC” in the marketplace. Company websites and blogs claim that their free weights, machines, weighted wearables, and resistance bands are the best to own without justification.


Some years ago, I published a 21 page meta-analysis of RT: which reviewed the current evidence for all forms of resistance training. There have been 1,300+ readings of that article on ResearchGate alone to date. I have advocated for change in the misrepresentation of resistance training standard of care exactly as Dr. Jacobs suggests, with some level of success.


Dennis Shavelson, DPM, CPed, Tampa, FL



From: Carl Solomon, DPM


This goes beyond commercial entities and advertising. Several years ago, I attended a presentation at one of our seminars. The speaker was a nationally recognized colleague and I believe the topic was infections. He posed a question to the audience (I don't remember specifically) was either "Do you ALWAYS order antibiotics for infected ingrown nails?"...or "Do you ALWAYS get a C&S before ordering any antibiotics?"...or  "Do you ALWAYS get x-rays for an infected ingrown nail?"...or "Do you ALWAYS administer Abx prophylaxis prior to bone surgery?" The specific question isn't the issue. He asked for a show of hands indicating who does. Of an audience of probably 150 attendees, very few raised their hands. He then scolded us, saying that the "standard of care" was that we should ALWAYS do that. 


Excuse me...didn't the response of that audience (assuming it's a fair representation for this locale) just define that the standard of care is that we do NOT always have to do whatever it was? How can someone who comes from a couple thousand miles away define what OUR standard of care is? When we let these things go unchallenged, there can be scary ramifications.


Carl Solomon, DPM, Dallas, TX



From: Jim Rief


Gill Podiatry has sodium hydroxide in stock.


Disclosure: Jim Rief works for Gill Podiatry. 


Jim Rief, Strongville, OH



From: W. David Herbert DPM, JD


Because I am close to 80 years old, I would personally not be interested in a degree change. Because I have a wife who has taught in several college level nursing programs and two cousins who have practiced dentistry for decades, I have a little different perspective about what is going on in medicine. We must look at the whole picture and must look at the whole forest and not be caught up with looking at just a few trees or maybe a few large bushes.


The big issue is that NP equals DO and MD. I can guarantee you that NPs will never be required to pass any tests that DO and MD students have to pass. Yet, legislatively at least in a number of states, they are considered equivalent to MDs and DOs. I have heard several well-known politicians state that robots and computers will replace physicians. Our students have been dumbed down by our school systems for decades! 1984 came about just 30 or so years late.


W. David Herbert DPM, JD, Billings, MT



From: Ivar E. Roth, DPM, MPH


Dr. Slowik is correct concerning perception by our peers. If you act like a physician and think like one, than you are one. If you walk the walk and talk the talk, others will see you as you want to be seen. I personally have carved out a niche in my community as a concierge podiatrist and it is working wonderfully. You are what you believe you are. Think positive and the results will follow.


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



From: Paul Kesselman, DPM


Having shared an office with a PCP for over thirty five years and practicing podiatry for just a tad longer than that and being a patient of a PCP and a myriad of medical/specialists, I feel not only qualified but obligated to respond to this thread. There is no way that I, as a practicing podiatrist, whether I had an MD/DO or DPM degree want to be compared to an NP, nor can I state that I am as qualified as they are to provide primary care. I have seen not only what the PCP does but what the NP does in the primary setting as both patient and provider. I have also been to four different specialists for a variety of routine issues (nothing serious fortunately) in the last two months.


When they ask me about or I state certain things which are related to primary care, the MD/DO specialists immediately state that's not their area of expertise. The same is true for the NP in...


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



From: Bryan C. Markinson, DPM


Dr. Herbert thinks that podiatrists should be able to provide primary care, right now! Really Dr. Herbert? He supports his belief by reminding us that nurse practitioners provide primary care. Indeed, they do. At least 20% of my patients in my hospital-based practice are cared for by nurse practitioners for their primary care needs. That is also increasing rapidly. I am all for advancing our profession, and it is not easy to be critical of anyone's position that supports advancement without appearing to be obstructionist. I'll risk it.


Dr. Herbert's assertion that "we can sure argue that our training in the medical and surgical sciences are much more intense and in depth than that of nurse practitioners" is not only preposterous but an embarrassment to have to read in a public forum. There is no valid way to even compare the educational experience of the NP and the DPM when the eventuality of providing primary care is the parameter being discussed.


I know not one single podiatrist, practicing as a podiatrist, or any RRA trained podiatry resident, who can perform as a provider of primary care, or come close to the knowledge and skill of a nurse practitioner engaged in the day-to-day practice of primary care. But don't worry Dr. Herbert, I know not one foot and ankle orthopedist who can perform primary care either or who would ever assert that they could be as good as a nurse practitioner providing primary care. Incredulous proclamations are not the way to go.


Bryan C. Markinson, DPM, NY, NY



From: Elliot Udell, DPM


Comparing podiatric physicians to nurse practitioners and then asking why DPMs should not be allowed to practice full body medicine if NPs do it all day long, is an unfair comparison. Why? From the get-go, registered nurses are highly trained in full body medical practice. In the hospitals, they have and always will be responsible for general medical care under physician orders, 24/7. Nurse practitioners have to have a masters or doctorate on top of that intense training. According to the NP association, nurse practitioners see over 1 billion patients a year for general medical care. These men and women are highly trained. 


On the other hand, we DPMs are better trained in the medical and surgical aspects as it pertains to the lower extremities. The bottom line is that if I am going to my allergist or going to urgent care, I have no problem being evaluated by a nurse practitioner. At this point in time, I would have a problem being evaluated by a colleague of mine for a non-podiatric problem. Should the clinical training for podiatrists change and the amount of general medical clinical hours become on par with nurse practitioners, MDs, DOs, and well trained PAs, then I would have no problem allowing a fellow podiatrist to evaluate me for a GI, cardiac, or any other medical problem.


Elliot Udell, DPM, Hicksville, NY



RE: The Passing of E. Darryl Hill, DPM


Dr. E. Darryl Hill, 71, of Unity Township, departed this life on Wednesday, May 26, 2021 at UPMC Shadyside. Darryl attended Boston University where he shined on the football field and was named team co-captain in 1970. Darryl played in the NFL for the New York Giants and the Houston Oilers.


Dr. E. Darryl Hill


Upon graduation from the Ohio College of Podiatric Medicine, Dr. Hill began a podiatry practice that spanned more than three decades across western Pennsylvania, including offices in Indiana, Greensburg, and Meyersdale. Darryl had an immense personality and presence, lighting up any room he walked into and making those who met him all the better for having done so. 


Source: [5/29/21]



From: Eric Lullove, DPM


About three years ago, I did the overhaul of my phone system. I got rid of my outdated analog system and went with a PolyCom digital system provided by my Fiber Internet provider. Every prompt created and introduction message is done digitally. I hired via Fiverr, a voice actor to do my introduction message and background music from Audioblocks.


Every prompt for afterhours, billing, prescription refills, consultations, and emergency calls is handled via the digital system. Voicemails are transcribed and sent to my phone via MP3 format. I have no further need for an “answering service” as it is already built into my digital communications package that I pay monthly for. The package includes 4 phones, 4 lines, a dedicated Internet fax server, and 100MB dedicated fiber optic Internet.


Eric Lullove, DPM, Coconut Creek FL

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