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03/28/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Ivar E. Roth DPM, MPH, Pedro Abrantes, DPM
Doctors! Medicare has made it clear that if you bill for these injections, be ready to pay back everything you were paid and go through the hassle, etc. Why not just tell your patients it is NOT a covered service and charge them cash up front. That is the way to go without worrying about big brother at your back.
Ivar E. Roth DPM, MPH, Newport Beach, CA
I’m on the ethics committee and Director for Podiatry for the American Academy of Stem Cell Physicians (AASCP). We have put out statements to help MDs, DOs, and DPMs understand that regenerative medicine therapies, including amniotic injections, are not yet recognized by the FDA for approval and should not be billed to insurance carriers. This topic was also discussed with the director of the FDA, Dr. Peter Marks, at the AASCP conference. Even with successful cases in trials with investigational new drugs in place, as well as many well published articles, there are still bad actors in the industry.
Most of the blame falls on reps stating that these are allografts and are reimbursed under such codes to push the product. If you are getting good success and document properly and are not offering guarantees, and your patients can afford these adjunct regenerative therapies, this will remain as a viable treatment option in the area of podiatry. Most of our liability insurance companies (such as Medpro) will also cover such therapies offered by doctors, if you use sound judgment. This should be considered as “non-covered“ services by carriers as with any other service we offer.
Pedro Abrantes, DPM, Miami, FL
Other messages in this thread:
03/31/2026
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Richard A. Simmons, DPM
I have not used a grinder for debriding toenails in more than twenty years. I saturate the nails with a mixture of water with hand soap and use my nipper to reduce the nail plates. When finished with the nipper, I use a surgical hand rasp to smooth them out. During my initial debridement, I am dictating my notes to my transcriber who goes through all the class findings and the complete lower extremity exam.
For subsequent visits, I rarely bill anything more than CPT 11720 and often only debride one toenail and bill the rest at G0127, that is only trimming the length of the nail and not reducing its thickness. All of my initial Medicare patient mycotic toenails are sent to the lab for determination. My practice focuses on the medical management of mycotic toenails with debridement as secondary.
Richard A. Simmons, DPM, Rockledge, FL
07/31/2024
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
RE: Do you charge for no-shows?
From: Kristin Happel, Marco A Vargas, DPM
As a practice consultant, I advise against no-show fees and getting new patient "deposits". Some of my clients follow my advice, some don't. One guess as to which clients have more successful practices.
Kristin Happel, Chicago, IL
I find this topic an interesting one. Since the pandemic, the no-show rate in my practice has increased significantly despite all kinds of text, email, and voice reminders being sent, and I have heard the same complaint from many of my colleagues. Many of my MD colleagues in my area are charging for no-shows and even eyebrow threading shops and manicure/pedicure shops are charging no-show fees too. Incredibly, some restaurants are now requiring a DEPOSIT to even reserve a table! Yet many podiatrists seem scared when it comes to collecting money from patients for our fees and services when they shouldn't be. It's the way of the world - deductibles are high and insurance covers less every year. Have you been to the dentist or the dermatologist lately? They have no problem collecting cash and in large sums at that.
What is the logic behind not charging patients who don't show up a fee for fear that you may scare them away? They're not showing up anyway! And if they decide they aren't going to pay it, that's ok. If they want to reschedule at some point in the future, they'll have to pay it before another appointment is given and in the meantime you just got rid of a patient who doesn't pay. I think that in this day and age, a reasonable no-show policy that includes a penalty for repeat offenders or blatant disregard of the appointment lets the patient know the importance of keeping the appointment and is an effective way to reduce no-shows. It certainly has had that effect in my practice.
Marco A Vargas, DPM, Sugar Land, TX
07/30/2024
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Jack Ressler, DPM
When I was working, we never had a policy of charging a fee for a no-show. Between handing out appointment cards and confirming patients the day before, our no-show rate was very low. We were fortunate enough to have a busy practice so an occasional no-show was not worrisome. Conversely, I would think a practice with lower patient appointments would think twice about charging for no-shows for fear of losing a patient. As we all know, patients can be very fickle. Keeping patients happy seems like the way to go.
Jack Ressler, DPM, Boca Raton, FL
07/29/2024
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Ivar E. Roth DPM, MPH
I wanted to add to my recent post as to why we charge for no-shows. First, all patients sign a document clearly stating our no-show policy. We have that policy online when they make an online appointment that they must read and accept. We call, text, and email every patient at least once or twice before every appointment. Just this overzealous communication concerning their appointments has drastically reduced the no-shows. However, for the few that are chronic or do not care, despite our Herculean efforts to notify them of their appointments, we do sometimes bill a no-show. The policy is hardly a money-grabbing situation. We work hard to make sure our patients are responsible like we are.
Ivar E. Roth DPM,MPH, Newport Beach, CA
10/18/2023
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Chuck Langman, DPM
So I’m curious. I’m on the board of an opioid foundation and am wondering why a significant percentage of docs would say they are against residents learning about pain management and opioid abuse.
Chuck Langman, DPM, King of Prussia, PA
10/17/2023
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Robert G. Smith DPM, MSc, RPh
I would like to thank PM News for posting this survey question as well as the 373 respondents. Perhaps APMA will have an opportunity to address this question at their House of Delegates meeting if/when a resolution with this central theme is presented. I appreciate the fact that a change in curriculum may increase the cost for the program.
Given there is no national oversight for the opioid settlements, there is state oversight. My research has revealed that funds will be set aside for medical post-graduate training for safe opioid prescribing, monitoring, and detection of substance use disorder in some states. I believe our podiatric profession should share in these funds. I have written to each attorney general, acting as the founder/president of my educational non-profit (501(c)(3), inquiring about an accounting of opioid settlement distribution.
Robert G. Smith DPM, MSc, RPh
10/12/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Mark Tanenbaum, DPM
Podiatry is a multi-faceted profession. As an old timer (since 1980), I always felt podiatric surgeons should perform surgery and podiatric generalists should not. As dentistry is not a specialty within medicine, so is podiatry. Therefore, a podiatric surgeon must be differentiated from a podiatric generalist. Both specialties can have sub-specialty certifications such as in wound management, biomechanics, dermatology, geriatrics, etc. A combined board will be divisive and professionally destructive, especially if a graduate is unable to get the appropriate training or pass the surgical board.
Mark Tanenbaum, DPM, NY, NY
05/13/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 1B
From: Paul Kesselman, DPM
I am one of three podiatrists in my large extended family along with many other MD specialists. Of all the podiatrists in my family, all of my generation, none have children who went into podiatry or medicine. As for all my relatives who are MD specialists (there are at least 9 in my generation), only one has two of four children who went into medicine.
There are two MD couples, neither of whom have children, who went into medicine with one of the MD couples being involved as chair of a department at a large tertiary care hospital. As for my undergraduate and earlier schoolmates, none of those who went into any form of...
Editor's note: Dr. Kesselman's extended-length note can be read here.
05/13/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 1A
From: David E. Samuel, DPM
On target once again Dr. Jacobs. Making a good living is one thing. Daily fighting with insurance companies, etc. can suck the life out of you. What we do is rewarding. The daily grind to achieve that and make a solid living gets worse. For my 3 boys, there is absolutely a better way to make a living than the energy expended on non-patient care. I would not recommend [podiatry] unless this was something they absolutely were hard fast and committed to in medicine; and then if would be allopathic for sure. None have chosen medicine, although one took his pre-med degree and decided on device sales and will continue to do quite well.
The parity thing is funny. Parity how? I don’t feel any less than any of the doctors I work with and who refer to us. We have mutual respect and...
Editor's note: Dr. Samuel's extended-length letter can be read here.
05/12/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 1A
From: Allen Jacobs, DPM
Studies demonstrate that only 51% of physicians would recommend medicine to their children as a career. Only 20% of medical school students have a parent who is a physician. A highly motivated and hardworking podiatrist can have a rewarding career in podiatry. There is no question that success is more difficult to achieve in podiatry than it is in allopathic medicine. In my opinion, and to my observation, the APMA has been of little benefit in advancing our education or positioning within the medical community.
Individual success in podiatry is almost totally dependent on individual effort at the local level. “Parity” as you discuss, can be achieved by your individual demonstration of knowledge and care, resulting in your own acceptance as an equal within the medical community. What the APMA has yet to appreciate is that you will not “legislate” podiatry into MD/DO parity. The recent USMLE debacle serves to reinforce this fact. When you are trusted with referrals of patients from other healthcare providers, you have achieved parity.
Allen Jacobs, DPM, St. Louis, MO
03/03/2022
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Robert Scott Steinberg, DPM
When do you predict, dropping mask mandates for the general public, will not trigger a new wave of infections? For me, I am not going to risk my patients' health, until public health indicators provides the data.
Robert Scott Steinberg, DPM, Schaumburg, IL
02/05/2021
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
RE: Participate in PM News Polls
From: George Jacobson, DPM
After reading the varying views on oral antifungal protocols and minimalist or barefoot function, I have no doubt why it is not difficult for the plaintiff's attorneys to find "expert" witnesses to testify to their theories of malpractice. Fortunately, both of these subjects appear have a preponderance of what could be the defense's views. I encourage all readers to vote in the PM News polls, so that we have the broadest views in the results of these queries and not just the same 800-900 respondents. I always look at the results and although they are not scientific, they are a good general indicator.
George Jacobson, DPM, Hollywood, FL
10/09/2019
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Elliot Udell, DPM
Kudos to Dr Steinberg for making it very clear that we all should practice the medicine that we preach and get vaccinated. For years, I have gone one step further and advocated on PM News that states should allow podiatrists to administer flu shots. This would be good for public health and since pharmacists in many states are allowed to administer flu shots, why not allow podiatrists to administer flu shots? Is there a profession more adept at giving injections than our profession?
Elliot Udell, DPM, Hicksville, NY
05/28/2019
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 2
From: Joel Lang, DPM
I am surprised and disappointed that over 1/3 of responding podiatrists are not CPR certified. It only takes a couple of hours and it could save a life. Why would anyone not want this training? Patients trust us with their health and lives. I had to administer CPR once outside of the office and was glad I had that training. It could save the life of a family member as well. Why would any practitioner of any specialty not take responsibility and acquire this skill. Go get certified.
Joel Lang, DPM (retired), Cheverly, MD
12/14/2016
RESPONSES/COMMENTS (PM NEW QUICK POLLS)
From: Dan Klein, DPM
Regarding podiatry school vs. medical school, Dr Tomczak, MD, DPM, EdD points out that 11 out 12 students chose DO school over podiatry while at the Des Moines school. This speaks volumes as to the preference of students and their thoughts about podiatry school and the profession! Having accomplished acquiring an MD degree, Dr. Tomczak, also speaks volumes as to his goals in life and his self-image.
I believe that podiatrists in general, given the opportunity, would choose the MD degree over the DPM degree in today's world. Having spent over 40 years as a podiatrist, the opportunities for advancement and placement in society were limited as a podiatrist compared to those of the MD. Even the military offered little advancement for rank for DPMs when compared to the MDs or DOs. Podiatrists have chased for recognition from Congress only to fail time and time again. I believe the dual degree should be offered to all podiatry students.
Dan Klein, DPM, Ft. Smith, AR
11/17/2016
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 1B
From: Al Musella, DPM
I agree with Dr. Peterson. Both poll questions are disturbing, but the responses to the one about selecting procedures to get the right mix for certification is more disturbing because WE are at fault. Podiatrists made those insane rules and WE podiatrists CAN and SHOULD fix them. Let's follow the lead of the orthopods who do not specify which procedure is performed, but rather what bones or joints are involved. Once you are cutting a metatarsal and putting in a screw - what difference does it make which way the cut goes? Get good at a few variations and use them. Break the foot up into a few areas and require a number of surgeries in each area. It doesn't matter which procedure is performed.
As for the insurance issues, the big one is of course routine foot care/debridement of mycotic nails under Medicare. In the old days, almost all patients would come in every month for maintenance care, and would never be in pain. Now patients are forced to wait until they are (needlessly) in pain - and for 61 days. These rules were also made up by a podiatrist, but it is too late for us to change it. The same is true with shockwave therapy for plantar fasciitis, and laser treatments of fungal nails - they would be my first choices - IF insurance paid adequately. I tell the patients of the options - but most just go with what is covered.
It isn't just podiatry. I am involved with the brain cancer community. They have a new-FDA approved treatment that is considered the standard of care by the NCCN. 90% of private insurances pay for it but Medicare doesn't. I have trouble getting a Medicare patient to pay $500 for orthotics. Imagine telling Medicare patients that they need a treatment that will cost $24,000 per month (for 2 years) and Medicare doesn't pay for it!
Al Musella, DPM, Hewlett, NY
11/17/2016
RESPONSES/COMMENTS (PM NEW QUICK POLLS) - PART 1A
From: Tom Silver, DPM
I completely agree with Dr. Gerald Peterson's statement that "Medical treatment should always be in the best interest of the patient, regardless of insurance coverage". Unfortunately, we often make the mistake of a preconceived decision regarding what a patient can or can't afford and either offer a lesser option, such as pre-fab inserts when they really need Rx. orthotics or only provide services that insurance will cover and not even offer non-covered alternatives that could help them.
I also feel that a certain percent of the time we tell patients that something isn't covered and they reject part or all of our recommended treatment for something they truly need. They respond with the famous words, "If it isn't covered by my insurance, then I done want it." This is often because of our failure to properly present the non-covered service to our patients so that they understand that this will take care of their foot problems and address their concerns.
Whether a patient has insurance or not, it's really frustrating how much treatment we don't provide to our patients when we don't listen to their concerns. We don't present treatment plans in an organized way that they would gladly accept. Dentists are masters at getting patients to go along with a treatment plan, regardless of cost. A colleague recently complained of a patient who said he couldn't afford to pay $400 for the orthotics he needed because he was paying off the $12,000 owed to his dentist!
Tom Silver, DPM, Minneapolis, MN
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