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08/22/2022    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Name Withheld


 


Until a few years ago, my local hospital always left open bottles of anesthetics in rooms for local injections. Then the hospitals started throwing them away and I received unopened bottles for each case. I thought this was a waste of money and likely some reason to reduce medical liability. I never found out. I often had a hard time getting Carbocaine in the past, even from my suppliers, though not other anesthetics. However, today I can't seem to get any from suppliers.


 


So, my solution is to request the bottles from the hospital when doing my few cases each month. So I get a bottle of Carbocaine and Marcaine. The staff turns their back when I take these open bottles, so they are not insubordinate to their employer. I feel perfectly comfortable using the opened bottles as I always have in my office when I purchased them from suppliers and seemed to be acceptable until a few years ago. I have rarely bought anesthetic over the years due to this surplus. Unfortunately, this won't help those who don't do some cases at the hospital.


 


Name Withheld

Other messages in this thread:


02/08/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Bret Ribotsky, DPM


 


I absolutely love the term "lecture police." What a great opportunity and responsibility to make sure that the opinions are: not biased, are not bought, or not completely just fabricated for a financial gain. I did this scrutiny when I was scientific chairman and president of the ACFAOM (now known as ACPM). In reality, the reason for my idea is that if the doctor is not licensed and they are being paid by a company, then isn’t he/she a vendor? And as a vendor, the audience is not allowed to get continuing education credits from that lecture.


 


Since I’ve been contributing to PM News since its inception in 1994, this topic has prompted more personal direct communication to me than anything else I have ever written about. I’m perplexed at why anybody would think that full disclosure is not appropriate. 


 


Bret Ribotsky, DPM, Ft. Lauderdale, FL

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 4



From: Keith L. Gurnick, DPM


 


Those of us who did not use or offer the "Cartiva" all lost many surgical patients who first sought out our opinions for surgical treatment for stiff or swollen or painful osteoarthritic 1st metatarsal phalangeal joints  (hallux limitus, hallux rigidus).


 


We gave them "patient specific" and "condition specific" current surgical options available of either a cheilectomy, shortening or PF osteotomy, joint replacement with an artificial "real" implant or joint arthrodesis-fusion, only to have some of those patients end up getting a Cartiva procedure elsewhere that went on to failure. How do we know? It's because some of those patients lost confidence in their "Cartiva" surgeon and returned to our offices for help. We spoke with those patients and they told us what they were told and why they had the surgery elsewhere. Broken promises.


 


Patients chose this procedure because they were told that it was less joint destructive, had quicker healing, had better range of motion, was salvageable in case of failure, and that the published research papers had shown excellent results. All of this has shown to be untrue for most patients. It is a shame that patients are so easily influenced by "direct to patient marketing" from the manufacturer, and also by the foot surgeon and on their websites as well  and how the public is all too often mislead.


 


Keith L. Gurnick, DPM, Los Angeles, CA

02/07/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Gregory T. Amarantos, DPM


 


In Illinois, we have been a part of the OPEIU for the past 25 years paying dues of $100/year. Our benefits are similar to the benefits of an AARP member. In a nutshell, we have received “bupkis”.


 


Gregory T. Amarantos, DPM, Chicago, IL

02/07/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Podiatrists Should Join Out-of-Hospital Multi-Specialty Groups


From: Daniel Chaskin, DPM


 


Why rely upon hospitals to purchase our practices and to dictate to podiatrists what to get paid for, how much time to spend with a patient, etc.? Total medical care cannot be given by a group of only podiatrists due to license and scope problems. Why not consider podiatrists joining or working with groups of primary care physicians and other specialists to give out-of-hospital-based primary care plus specialty care which includes podiatry? What if the medical group was also part of an independent IPA?


 


This will result in total care of the patient population, without relying upon hospitals to dictate what we do. This care will be cheaper than that of the care given by hospitals. The medical group shares expenses and revenues. Just because one agrees to share expenses and revenues does not mean you get into the group. The problem is the medical group may not accept you. Getting the group to accept you is a big hurdle. You must have experience, some knowledge of different medical conditions and how they affect the foot, as well as be well liked by patients. This out-of-hospital group medical care is the future of healthcare which includes podiatry care. 


 


Daniel Chaskin, DPM, Flushing, 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 2


RE: It's Time for Doctors to Unionize


From: Jeffrey Kass, DPM


 


My friend’s wife asked me if I received any money from the city for working in healthcare during the covid crisis. I replied I had not. She showed me she just received a check for about 1,700 dollars. She replied, “America is a great country; they give money to you for free.” I asked what she meant by that. She replied, "I’m a school psychologist; I zoomed during Covid from my house." I was happy my friend's wife got her “free money” and a little annoyed that I continued to see patients in both my office and the hospital and didn’t receive my “free money”. 


 


I inquired why she felt she received the money and she replied, “because we have a good union and they open their mouth.” It seems unfair to me that doctors can’t unionize and/or strike. To some extent we are powerless. 


 


Jeffrey Kass, DPM, Forest Hills, NY

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 4



From: Paul Kesselman, DPM


 


Kudos to Dr. Allen Jacobs for a superb essay on the issues surrounding Modern Vascular. Many of our colleagues in all fields of medicine steer their patients to facilities such as ASC where they are part owners. More recently, an orthopedic implant manufacturer was convicted of incentivizing an orthopedic surgeon by providing millions of dollars of free implants for surgeries performed out of the USA. In return, the surgeon also performed many of those same surgeries here in the U.S. using these same implants. Just today, an ENT surgeon was also found guilty of re-using sinus implants costing the tax payers millions of dollars.


 


I wholeheartedly agree (as we all should) with the last paragraph of Dr. Jacobs’ recent essay, that is “The decision not to act is a decision.” For those who wish to act responsibly, contacting a healthcare attorney is the responsible measure to...


 


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

02/04/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Connie Lee Bills, DPM


 


Wow. That is eye-opening. I have been disgusted with the way the federal government treats doctors for the past decade. Thanks for bringing this to light.


 


Connie Lee Bills, DPM, Mount Pleasant, MI

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 3



From: Tip Sullivan, DPM


 


ALLOWED To lecture? I didn’t know that anyone (including podiatrists) had the authority to generally allow or disallow someone to lecture. I always thought that whoever was organizing a lecture series was responsible for getting the lecturers. I hate the idea of lecture police! Let the individual sponsor decide and keep our nose out of it. If there is a problem, then people will not attend and the issue takes care of itself—if you consider it an issue.


 


Tip Sullivan, DPM, Jackson, MS

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 2



From: Todd Rotwein, DPM


 


Dr. Ribotsky poses an interesting, and complicated, question. My response is, suppose we have two doctors, one whose license was revoked because of a driving while intoxicated infraction; and another who lost their license as a result of substandard patient care. Should they be treated the same?


 


Todd Rotwein, DPM, Hempstead, 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 2



From: Robert Scott Steinberg, DPM, Richard Jaffe, DPM


 


Thanks, Rem, but no thanks. I am 100% against the continued dumbing-down of what we do. Rem, you could write 10,000 words that would not be as effective as my profession referring to ourselves as podiatric physicians and surgeons. Do you realize how many people's grandmothers saw a chiropodist/podiatrist? I bet most Americans don't know how far beyond that my profession has come.


 


I figured this out a long time ago. My department at Humboldt Park Health (formerly Norwegian American Hospital) is the Department of Podiatric Medicine and Surgery. We have had a residency program since 1988.


 


Robert Scott Steinberg, DPM, Schaumburg, IL


 


Regarding DPMs who don’t call themselves podiatrists: We have a great podiatrist in the House of Representatives who calls himself a “physician” in everything that I have read about him. Please correct me if I am wrong but, it seems that a movement to properly identify ourselves should begin at the top. If those who we respect cannot do it, then don’t expect much from the rest of us. 


 


I have always identified as a podiatrist here in Israel where they couldn’t believe that a non-MD could perform surgery of any kind. It was the only way to establish the profession in a new country. It is not expecting too much for podiatrists in America to properly identify themselves where most people already know about the profession.  


 


Richard Jaffe, DPM, Jerusalem, Israel

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

01/30/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Rem Jackson


 


I read Dr. Kornfield’s response to Dr. Roth’s post, re: DPMs not calling themselves podiatrists and his suggestion that better PR is the answer, and Iwholeheartedly agree. If the APMA, for example, created a PR campaign that could be distributed through all the channels available today that was designed as Dr. Kornfield suggests to make the word "podiatrist" synonymous in the minds of the public with “medical and surgical management of the foot and ankle”, it could have a decidedly positive effect in the public’s mind.


 


A national campaign like this would be prohibitively expensive for any group to initiate (GEICO spends millions so that we know “15 minutes can save you 15% or more on your car insurance”). If provided to all members who could use it on their websites, in their emails, in their social media, and in all their marketing efforts, it could have a significant national reach and make great strides toward bringing the profession and the word podiatrist into public awareness. I couldn’t agree with Dr. Kornfield more. 


 


Rem Jackson, CEO, Top Practices

01/27/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3B



From: Carl Solomon, DPM


 


Get OVER it - we’re podiatrists…we’re ALL podiatrists!


 


You cannot compare our situation with that of the dentist and specialist dentist. An oral surgeon, maxillofacial surgeon, or whoever specializes in oral surgery. An orthodontist specializes in orthodontics. A periodontist specializes in periodontics. They’re all dentists. BUT – they stick to their specialty. They depend upon referrals from general dentists and won’t bite the hand that feeds them by doing routine procedures like filling cavities. Podiatry has always been a surgical procedure-based profession but there has been an evolution of more advanced surgical training.


 


I know very few, if any, podiatrists who truly "specialize" in RRA procedures to the extent they...


 


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

01/27/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A



From: Robert Kornfeld, DPM


 


While I understand Dr. Roth’s point of view, I don’t think we are in need of a name change as much as we need better public relations. I can tell you that after 43 years as a podiatrist, I still often meet people who have no clue what our training and scope of practice is. But they do mostly know the training and scope of MDs. I have always believed that better PR would make the word podiatrist synonymous in the minds of the public with “medical and surgical management of the foot and ankle”. After all, that is what we do.


 


Robert Kornfeld, DPM, NY, NY

01/27/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Randy Anderson, DPM


 


Actually, the avoidance of protectionism and allowing increased access to privileges are the reasons behind the requirement/opportunity for the applicant to show that an alternate certifying body is equivalent to the accepted certifying body.


 


Given your experience on a credential committee, I am sure you are aware there are certifying bodies for a multitude of activities beyond surgical specialties. For each of these, there was an initial organization that developed specific standards that had to be met in order to achieve certification, and generally speaking that initial body is the...


 


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

01/27/2023    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Howard Zlotoff, DPM


 


I am responding to discussions about granting privileges to podiatrists in a hospital or surgical center setting. The notion that the medical director and chairman of the department that oversee podiatric services independent of outside board certification is both dangerous and flawed. 


 


The process cannot be objective if competing practitioners, i.e. podiatrists, orthopedists, and surgeons are the primary gatekeepers of surgical privileges to be granted. The obvious conflict of interest will be challenged if the applicant is denied privileges requested. Recognized surgical board qualification/certification must be the determining factor as the primary tool used to grant use of the operating room. This protects the department, the hospital, and most importantly the safety of the patient. Yes, the department chairman should have input to review the procedures that the applicant has performed in the past and those procedures they are requesting. New technologies, e.g. laser, arthroscopic, fixation systems evolve and, through continuing education and workshops, new and existing department members must demonstrate competency of these advances also. 


 


My experiences creating and chairing several hospital podiatric departments taught me how critical this process is, and it must include objective gatekeeping blended with individual procedure granting for every member of the department. Again, the ultimate safety of the patient, who assumes their doctor is competent, must be the goal. It is a huge responsibility not to be taken lightly. Our national organizations who create these Boards must understand how important their mission relates to public safety and professional competency. 


 


Howard Zlotoff, DPM, Camp Hill, PA

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
ASPMA


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