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RE: Payers Increased Use of Electronic Payments

From: Paul Kesselman, DPM


A few weeks ago, there was a story in PM News regarding payers increased use of electronic payments, to which I offered additional comments. Here is a story that came across my desk entitled: Electronic Payment Adoption Key to Healthcare Industry Savings


Paul Kesselman, DPM, Oceanside, NY

Other messages in this thread:



From: Donald R Blum, DPM, JD


My dermatologist accepts Medicare assignment but does not accept other insurances. When you accept assignment, it is "ONLY" for services that you know are not excluded from coverage. For services that are excluded, you can accept payment at time of the service. 


If you follow the CMS rules and guidelines strictly, I think you should do okay. All services provided to diabetic patients (whether on Medicare or not) are not necessarily a covered service if the patient does not meet the class findings (Q7, Q8, Q9).


One more item - remember for 2022, there may be a decrease in the Medicare reimbursements (due to fee reductions and sequestrations).


Donald R Blum, DPM, JD, Dallas, TX



From: Ron Freireich, DPM, Burton Katzen, DPM


We had this exact problem here in Ohio and we checked with our patients to see if they initiated the refills. They too did not request the refills.  We filed a complaint with the State of Ohio Pharmacy Board. The faxes quickly stopped.


Ron Freireich, DPM, Cleveland, OH


Unfortunately, with the single sheet faxes of today, even when you mark unsubscribe, they still keep coming and it is hard to stop. Many years ago, I was getting 3-4 faxes a day from one company advertising office furniture. At the time, we had a fax that used a paper roll, and I attached 3 pages together (top of the 1st one to the bottom of the last one) that said UNSUBSCRIBE, called the number and left for the night. Surprise!! No more faxes from them. I always had a vision of them not being able to get in the office the next morning because of the mass of paper blocking the door.


Burton Katzen, DPM, Temple Hills, MD



RE: Autofax Pharmacy Refills

From: Keith L. Gurnick, DPM


My office often receives far too many faxes from pharmacies asking me to authorize prescription refills for my patients. This past year, before authorizing or declining the refill, I called or sent an e-mail to each patient, asking them if they wanted or needed the refill and if they had requested the refill. To my surprise, almost 100% of the time, the patient said they knew nothing about the fax, and had not initiated any request and they did not need the medication any longer.


My office is inundated with faxes on a daily basis from outsourced carriers asking for medical records, physical therapists who send cut and pasted medical records asking for my signature and a return fax to authorize continued care, and these unwanted faxes from pharmacies for prescription medication refills that were never requested by anyone. My office has to send back a reply fax to the pharmacy denying the request for the refill, or they will continue to send the faxes many times.


Any suggestions on how to curtail these endless unwanted faxes would be appreciated. I am aware that I could get rid of my fax machine but I also receive faxes (MRI reports, etc.) that are important such as insurance credit card payment vouchers and others. Can't something be done on a legislative level to stop the pharmacies from auto-faxing prescription refills when no one ever asked for the refill?


Keith L. Gurnick, DPM, Los Angeles, CA



From: Elliot Udell, DPM


Kudos to Dr. Simmons for bringing up an issue that has long affected and annoyed all of us. When we write a prescription for a topical antifungal, we never know if the patient's insurance company will either allow it, reject it, or hit the patient with a "million dollar" co-payment for it. The latter will generally result in either the patient and/or the pharmacy chasing after us to try to find an alternative antifungal that is covered with a reasonable co-payment. 


Since many topical antifungals are OTC products and many of our podiatry suppliers are happy to stock our shelves with them, dispensing these products is a good option. If the patient must get the medication via his or her pharmacy, one method that has worked well with us is to write for a specific cream and give the pharmacist permission to substitute an alternative topical antifungal that is covered by the patient's insurance company. This avoids calls back and forth from the pharmacy while the pharmacy staff searches for the product that will be covered. 


Elliot Udell, DPM, Hicksville, NY



From: Dieter J Fellner, DPM


Reinforcing the notion of a Cinderella service since time immemorial, the podiatric physician-surgeon is not 'permitted' to administer COVID-19 vaccinations. There is an extensive, and growing, online debate about the fact that those staff, with lesser training and education, yet legally empowered to do so, have no idea about aspiration, prior to injection. 


Increasingly, the intravascular injection is now linked to adverse health sequelae, such as increased coronary syndrome with a spike in myocardial infarctions. This important aspect of injection technique is second nature to all podiatrists. This is a global problem. Our 'leaders' are again failing the nations of the world adding to their catalogue of shame in managing this 'crisis'.


 Dieter J Fellner, DPM, NY, NY



From: Elliot Udell, DPM


This issue has been discussed for quite a few years in this forum. Why is it that pharmacists can administer many vaccinations and podiatrists and dentists who give injections all day long, cannot? During the height of the first wave of the COVID-19 pandemic, some states in the U.S., including my own, issued temporary permission for podiatrists to administer COVID-19 vaccinations but only under the supervision of one of the other professionals.


A number of our colleagues took advantage of this and generously volunteered their time giving shots at mass vaccination centers. The fact that this did not lead to allowing us to give flu and COVID-19 shots permanently, does not do justice to the public, especially in areas where a podiatrist or dentist is the only healthcare professional that some elderly people see.  


Elliot Udell, DPM, Hicksville, NY



RE: No Sane Rationale for Prohibiting DPMs to Vaccinate

From: Name Withheld (TX)


I do not understand the world we live in. In Texas (and perhaps other states), DPMs cannot give flu shots or COVID-19 vaccines. Is this insane? RNs, LVNs, NPs, and mid-levels can give these injections but not podiatric physicians. DPMs are trained in administering injections and dealing with adverse reactions much better than the local pharmacist. The reason given for not allowing DPMs to give these vaccines? Flu and Covid are systemic illnesses. Crazy!


Name Withheld (TX)



From: Burton J Katzen, DPM


After reading Dr. Wallace's "Advice from a Retiring Podiatrist", as another podiatrist contemplating retirement, several things come to mind.. My first thought was of Mickey Mantle, Willie Mays, Sandy Koufax, etc. who were "born too early". I believe Dr. Wallace would have been happier in our wonderful profession practicing as a chiropodist in the 1st half of the 20th century. It's hard to imagine practicing the same way and with the same techniques as when I graduated in 1971 and not trying to learn new innovations and techniques.


I can't help but feel sorry for him that his way of practicing has robbed him of the utter joy of permanently correcting thousands of painful deformities of his patients and the joy of trying new innovations that might have greatly improved his patients’ outcome and lifestyle. However, if that worked for Dr. Wallace, neither I nor anyone else should judge the way he practiced.


I find it hard to believe that Dr. Wallace's other such positive lifestyle choices, which I mostly agree with, are in such conflict with the advice he has given; with the possibility of permanently changing lives and allowing his patients to partake in the same joys of life, one such joy being long non-painful walks by providing the latest treatment options available, basically advising us to stay status quo as a profession. Anyway, if another close-to-retiring podiatrist might give advice, do whatever it takes to achieve the practice and life goals you have set for yourself, keep learning, and advancing your skills, give your patients the best and latest treatments available, and don't listen to anyone else's advice on how you should live your life or practice your profession.


Burton J Katzen, DPM, Temple Hills, MD



From: Stephen Musser, DPM, Ivar E. Roth DPM, MPH


Well done and written. I agree with every point you mentioned. For those of our colleagues who have been practicing less than 8 years, you will come to find this advice is well thought out and true.


Stephen Musser, DPM, Cleveland, OH


Congrats on your retirement George. Thanks for your advice. I would add though, that if you are conservative and do NOT sell surgery, you should inform patients and let them make the decision to have surgery or not; you will save yourself a lot of headaches. You will do less surgery, but since the patient made the decision, you will be safe from criticism.


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



RE: Why Doesn't Government Help?

From: Jeffrey Kass, DPM


If the government wants doctors to report information so badly, i.e. MIPS and/or MACRA info, why doesn’t it provide the resources to the doctors to perform those tasks? Similarly, if they want all providers to be utilizing EHR, would it not make more sense for the government to supply the program free-of-charge so that everyone would be utilizing the same program? This way, when someone logs in, they will have access to their patients' charts. This would be a productive way to prevent duplicity of testing and make records easily accessible to other providers. 


Instead, all doctors are paying computer programmers, registries, etc. and doctors are still ordering duplicate studies and having difficulty getting reports or studies from other doctors. Bottom line seems to be a negative for doctors. One would think it may be smart to make life easier for doctors so that they could devote more time to the care of their patients. 


Jeffrey Kass, DPM, Forest Hills, NY



From: Name Withheld 1, Neil Levin, DPM


Like Name Withheld, I have not been able to fill out this time-consuming form and will be paying my CPA money to complete it. I never asked for the funds, nor did I sign an agreement prior to the funds showing up in my bank account. I had no way to refuse the funds. I wonder what legal recourse the government really has if I never agreed to terms? This reminds me of the line, "I'm from the government, I'm here to help you."


Name Withheld 1


I too, thought the HRSA reporting was quite daunting, especially the 35-page pdf they offer for "instructions". There is a help line number to call on the e-mail letter you reference. Before you incur expensive professional accounting fees, try calling the help line. They answered quickly and they were knowledgeable and helpful. I called them several times during the reporting process. 


Neil Levin, DPM, Sycamore, IL



From: Marc S Jaffe, DPM


I recently contacted the NYSPMA to inquire as to whether the NY22 Clinical Conference would be available streaming online. It appears that they are not interested in accommodating their older/immunocompromised members this year. I explained that as an over 65 caregiver for an immunocompromised spouse, I was not willing to congregate in large groups or to take NYC public transportation to get there. I was told that a virtual streaming option will NOT be available, despite the fact that many members have requested it. Needless to say, I was very disappointed. Perhaps NYSPMA should poll its members.


Marc S Jaffe, DPM, Woodbury, NY 



From: Ron Freireich, DPM


Dr. Kass mentions a few of the many expenses that are rising, and this trend is certainly going to get worse. The other side of this perfect storm which has been brewing for many years is continued decreased reimbursements. Dr. Kass is 100% correct in saying that this model is not sustainable. The difference between healthcare and what other businesses are doing is that we cannot pass our increased expenses onto the consumer.


Not only are new graduates not going to be able to pay back student loans but they, along with everyone else in healthcare, are going to be unable keep up with paying any of their bills. It’s a no-brainer; when expenses are more than payments….it’s over.


Ron Freireich, DPM, Cleveland, OH



From: Elliot Udell, DPM


A year ago, we were paying "five dollars" for a box of gloves. The same box is now over 13 dollars a box. If it were just an adjustment for inflation, it would be six dollars or seven dollars a box; but close to a 300% rise? That's price gouging and I wonder why there are no legal controls over it. 


Now it’s not just gloves. My car is on its “last wheels" and I am encountering the same gouging in the auto industry. A car that was offered to me two years ago for $350 a month is now over $700 a month, and I am not talking about a Lexus or Mercedes. The bottom line is that something is going on behind the scenes in lots of areas of life and I hope that someone in Washington starts looking into this or our entire economy will be in for a rude awakening.


Elliot Udell, DPM, Hicksville, NY 



From: John D Lanthierm BSc, DPM


I fixed the same dilemma that you are facing now as I have been using Dragon Medically Speaking for many years. I just upgraded my office computers to more powerful computers but only the Dragon one would work.


I know that it is subscription-based and has a monthly cost; however, unequivocally, it is the best dictation system that I have ever used. I bought a Philips microphone with it as I dictate in my office after seeing patients and I want a quality microphone to reduce errors; however, I use an app that is provided on my iPhone and now dictate directly in front of the patient. All patients are completely impressed and it saves me an inordinate amount of time. The rate that it learns is amazing and the number of corrections is minimal after set up.


I recommend switching to the Dragon One system to save you time and increase your speed and efficiency. I do not have a pile of charts at the end of the day on my desk with the anxiety and stress of trying to remember what I did and trying to read my handwriting to remind me of what to write in the notes. I have so much more time for myself and am more relaxed at the end of the day. Yes, there is a subscription fee but it is well made up in the time and energy that it saves you.


John D Lanthierm BSc, DPM, Sudbury, ON, Canada



From: Ron Freireich, DPM, Robert Scott Steinberg, DPM


I was not aware of Dr. Christina's recent message encouraging the APMA membership to contact our Senators to ask them to vote yes on the Reconciliation Bill, and I have to say that I'm quite shocked by his request. I too am in favor of passing the HELLPP Act and agree with everything in Dr. Daniel's post. The additional problem that I have with Dr. Christina's request is that if this bill gets passed, it will also include the 2% Medicare payment cuts that was installed under the previous sequester. With all the pay cuts that we have endured over and over again, it's hard to believe that anyone would support a bill that will deliver further cuts to our bottom line. 


Ron Freireich, DPM, Cleveland, OH


It's too bad for podiatry that Dr. Daniel didn't bite his tongue for the sake of passing our HELLPP Act. Is it too much to expect that a 40-year APMA delegate would have put podiatry above their political views? Dr. Daniel has no right to embarrass our profession because of his personal right-wing politics.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Gerald Peterson, DPM


Wes, I’m sure with as long as you have been a member of the HoD, you should know APMA IS NOT ADVOCATING for passage of the Reconciliation Package but only advocating to include the HELLPP Act into the package! There is a big difference and you know that. So why do you post this inaccurate statement? We have long been working on this legislation and have had it attached to various other healthcare bills which we may not have agreed with either. 


It the end, the result should be the same and that is to get our bill passed to the benefit of our patients and for our profession. I agree the tab for this package is huge and who knows what it will end up being once they whittle it down, but anything will be too much for our kids. Hopefully, we can get the HELLPP Act passed some other way, but for now, it is one avenue we have to pursue! 


Gerald Peterson, DPM, West Linn, OR



From: Barry Wertheimer, DPM, W. David Herbert, DPM, JD


Just a "thank you" to Dr. Daniel for his thoughts on what is good for America and not just podiatric medicine. Does anyone really think this country will survive with the course the left is on? It baffles me to think anyone who is capable of thinking rationally could accept the direction we are going.


Barry Wertheimer, DPM, Southern Pines, NC


I completely agree with Wes Daniel DPM about our national debt. I disagree with how long it will take to feel the effects of it. I received my DPM in 1976 and remember the inflation of the late 70s. I think what we will be experiencing starting now and continuing for who knows how long will definitely be much worse.


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



RE: Encouragement to Contact Senators for Passage of HELLPP Act

From: Wes Daniel, DPM


During my 40 plus years of participation in the APMA House of Delegates, I have never been accused of being too quiet or too afraid to speak my mind in that or any other forum. I have faithfully trudged the halls of Congress each year in an effort to encourage our representatives and senators to support and pass legislative initiatives the APMA was touting at that time. I have done so with the HELLPP Act more recently and have also written and called my representative and Senators concerning this legislation and others. In a recent message from Dr. Christina, the general membership was urged to contact our Senators to ask them to vote YES on the passage of the $3.5 trillion so called Reconciliation Bill because the HELLPP Act legislation has become a part of this particular legislation. I had to bite my tongue at this but cannot continue to keep silent on this issue.


I am in favor of passing the HELLPP Act! However, I strongly believe the APMA has sold their soul in an effort to...


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



From: Jack Ressler, DPM


There are many systems available on the market. It comes down to which system works best for the individual and what fits their budget. The most common drill used by a majority of podiatrists and their staff is the Dremel variable speed drill. Our profession has been using them for many years. They are efficient, inexpensive, and not costly to repair and maintain. In time, the nail burr tends to not "seat" properly in the drill and can cause a very annoying vibration to the patient. Regular cleaning and maintenance will greatly reduce this problem. Many podiatrists are using micro drills. They do an excellent job with less maintenance required. The Medicool ProPower 35k is a great choice in this category. The only downside is the price. They are around four times the cost of a Dremel.


I manufacture an economical vacuum system that incorporates a canister vacuum and foot pedal. It is designed to be used with either the Dremel drill or Medicool ProPower 35K micro drill. I have both systems in my office and prefer the micro drill. They are lighter to hold and more comfortable to the patients because they don't vibrate. That being said, a large majority of my sales incorporates the Dremel drill.


Jack Ressler, DPM, Delray Beach, FL



From: Cindy Medders, CMA


Our practice uses the J-Vac. We have ordered over 30 J-Vac units throughout the years. These units have been highly efficient, economical, and virtually maintenance-free. Dr. Ressler has always given us great customer service. These units were designed and sold by Jack Ressler, DPM, who is a practicing podiatrist.


Cindy Medders, CMA, Atlantic Foot and Ankle



RE: "My Feet Are Killing Me"

FFrom: Joel Lang, DPM


I think the program "My Feet Are Killing Me" (The Learning Channel) is a great public relations entity for the profession. However, am I the only one who thinks that the doctor taking off the shoes and socks of an able-bodied patient is "weird"? My doctor does not help me undress. For one thing, the touching of shoes, which are inherently dirty, with or without gloves, contaminates anything else that might be touched.


When I was in practice, upon entering a room, the patient had already shed his/her footwear, but the feet were covered with a towel, so that the feet were not the first thing I met when entering the room. I was able to first focus on....


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



RE: Letter from Ben Walner of APMA

From: Jeffrey Kass, DPM


Point of reference: in the event anyone gets an email from Ben Wallner, FYI, he is the Director of Legislative Action for the APMA. The email contains links to call your Congress people to help pass the HELLPP act which is included in the reconciliation package. This is important as it would help recognize us as physicians under Medicaid.


I don’t know Mr. Wallner but I think it would be prudent that the email come indicating in the subject line that it is from APMA. I think colleagues who don’t recognize his name might not open the mail. I think the message is important and it is more likely the email would be opened from APMA vs. Ben Wallner. Having said that, I applaud both Mr. Wallner and the APMA on this advocacy.


Jeffrey Kass, DPM, Forest Hills, NY 



RE: Slip and Fall Prevention

From: Keith L. Gurnick, DPM


Podiatry has taken such an interest in slip and fall prevention for our patients and the public, with the implementation of gait training, physical therapy, muscle strengthening, shoes, orthotics, and AFOs, when indicated and medically necessary. Every one of our patients who sustains falls does not suffer from pre-existing conditions such as drop foot, peripheral neuropathy, or flexible forefoot valgus.


Here is a link to a site that includes other ideas we should incorporate into our discussions with patients and family members to help prevent slips and falls. This is even more relevant, especially for otherwise healthy elderly patients, but also for our patients who are suffering or recovering from strokes, hip or knee replacements, or have conditions that affect stability and gait issues like ALS, MS, and more.   


Disclosure: I have no affiliation with EMC Insurance Company.


Keith L. Gurnick, DPM,  Los Angeles, CA



From: David Secord, DPM


I have a brother-in-law who did a dental residency in Richmond, VA to specialize in endodontics. During an interesting conversation with him some years back, he explained that if you are trained in endodontics, you are not allowed to do general dentistry and could be disciplined if caught doing so.


I don't know how this is legal, as it seems like restriction of trade to me, as someone who does a root canal can certainly fill a cavity or make braces. As such, if his claim is true, that is NOT the model we want for our profession.


The humorist Will Rogers had a quip he would share, which goes as follows: "The World of medicine has become absurdly specialized. I went into the office of an eye doctor and told him 'doctor, I have something in my right eye. You have to help me'. The doctor responded 'I'm sorry, but I'm a left-eye doctor.'"


David Secord, DPM, McAllen, TX 
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