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From: Randy Anderson, DPM


We have had similar conversations at one of the hospitals where I am involved in leadership. How we address the issue of multiple certifying bodies is to have the applicant provide proof that the alternate certifying body is as rigorous as the traditionally accepted organization: examples such as ABFAS for podiatric surgery, AHA for ACLS certification, etc. This approach avoids charges of prejudice or bias against any specific provider or certifying body.  


This issue is also handled at the credential committee level as part of the credentialing process.


Randy Anderson, DPM, Mount Vernon, WA

Other messages in this thread:



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 



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



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



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



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



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.



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



From: Ivar E. Roth, DPM, MPH


Dr. Kornfeld makes a good point. As a general rule, there is no doubt that we are all classified as podiatrists. However, I think here in the U.S. that is now an antiquated term with the current requirement of 3-year plus residency training and fellowship-trained podiatrists. I believe a name change is in order and we should be known as podiatric foot and ankle surgeons.


I see no problem with that as oral surgeons complete a three-year residency as a dentist, and dentists that do no residency or a year are referred to as dentists. So the strict term "podiatrist" no longer applies to any residency-trained podiatrist who completes a minimum of three years of surgical training. What do others think... is a change of name in order?


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



RE: DPMs Who Avoid Calling Themselves Podiatrists

From: Robert Kornfeld, DPM


As a member of LinkedIn, I have been placing posts on a fairly regular basis. What I have come across has me perturbed. And that is the way many podiatrists have themselves listed. Most list themselves as a podiatrist or DPM. But there is an alarming number of podiatrists out there that avoid the word podiatrist. I have seen "Foot and Ankle Surgeon", "Fellowship Trained Foot and Ankle Surgeon", "Foot and Ankle Specialist", "Physician of the Foot and Ankle", "Podiatric Surgeon", among others.


The bottom line is they are ALL podiatrists, practicing foot and ankle medicine and surgery with a DPM degree. I can only assume that these doctors are not happy to be identified as a "podiatrist" and feel better when they change their title to something more impressive in their mind. This really hurts our profession and the way the public sees us as doctors. If everyone stopped feeling "less than" and...


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



From: Rod Tomczak, MD, EdD


I recalculated the statistical difference (in preferences) between podiatric and orthopedic patients using the same chi-squared test the authors used. I calculated a P value of 0.0485 which is statistically significant for a difference in the number of participants in each group (podiatry versus orthopedic patients). Practically speaking, the orthopedic patients would require a smaller number of favorable answers in any category to result in a larger percentage. But, the difference in the number of patients should cause the reader to be concerned.


In reviewing the tables, I noticed the numbers do not always add up to include the 262 participants nor do the percentages seem correct. That was a good place to stop reviewing it. There is always a concern with surveys when all the questions aren't answered. Table 4 indicates more patients sitting in an orthopedic waiting room thought podiatrists did a better job fixing bunions than orthopedists did. Regardless, most medical statistics are presented as confidence levels these days, not the old P values. I wonder if this study had a statistician review the statistics.


If we ask people sitting in a shul what religion they prefer, it would probably be Judaism.  The same for this study. Why would you go to an orthopedist if you prefer a podiatrist? I agree with Steve Spinner that the paper is self-serving, but on top of that, it is poorly written and not very strong, and I'm not sure it is deserving a Level II rating.


Rod Tomczak, MD, EdD, Columbus, OH



From: Mark Hinkes, DPM


I read the comment from Judd Davis, DPM about feeling trapped in the fee-for-service business model and not interested in changing to a "direct care "model. There is a third option for podiatrists. That option is the value care based business model which is being rapidly adopted by many integrated healthcare companies. The difference is dramatic. The focus of the fee for service business model is quantity of care (how many things can you bill for?) with no focus on prevention. The focus of value based care is 180 degrees away from that with the focus being on the quality of the care and promoting prevention.


In value-based care, providers are incented to keep patients healthy and they get paid from a pool of cash that is dedicated for the care of each patient. Podiatry does have a presence in the integrated healthcare world and will become more important in the future. This will happen due to the ability of podiatry to provide proactive preventive care for people with chronic diseases like diabetes, to prevent diabetic foot ulcers that will prevent costly hospitalizations and amputations.


For those practitioners who can see the future clearly, changing from a fee-for-service to value care business model will entail affiliating with an integrated healthcare company and that will be disruptive to an existing practice but it can be done. If I were a new practitioner, I would pass on the private practice fee for service business model and seriously consider affiliating with an integrated healthcare company that uses the value care business model.


Mark Hinkes, DPM, Nashville, TN



RE: The DPM/MD Controversy

From: Rod Tomczak, DPM, MD, EdD


The controversy concerning a degree change has been simmering for years and Podiatry Management has done an excellent job documenting both sides of the debate. While the arguments continue to simmer, podiatric educators have not input much lately. And now that the podiatry colleges have, for the most part, joined universities that grant MD or DO degrees, would these institutions condone a degree change or tolerate a podiatry college becoming a dual degree granting institution?


Some years ago, when I was a professor at the Des Moines school and Leonard Levy was the dean, we instituted a five-year program to grant a DPM/DO dual degree. During the second semester of the first year, the Commission on Osteopathic College Accreditation put an end to our experiment. We were told that...


Editor's comment: Dr. Tomczak's extended-length letter can be read here.



From: Pete Harvey, DPM, David Secord, DPM


Try Henry Schein for Polocaine 2%.


Pete Harvey, DPM, Wichita Falls TX


I switched to Ropivicaine and have had no problems with supply (so far).


David Secord, DPM, McAllen, TX



From: Elliot Udell, DPM


Thank you Dr. Oloff for shining a light on the commercialization of medicine. The example given was just the tip of the iceberg. Look at the commercials being advertised on television all day long. They advertise drugs for breast cancer, psoriasis, injections to control cholesterol, diabetes, etc. Some of these drugs may be very helpful, but many of them have side-effect profiles and only the patients' oncologist, rheumatologist, endocrinologist or dermatologist can determine if it is a right choice for a specific patient. 


I have a personal ax to grind. I am a breast cancer patient and there is one drug advertised all day long. They depict the people taking it as happy, family people going about normal lives with their children and grandchildren. I took the medication for three days and was ready to call 911 and the side-effects I endured were not rare but common to all who take the drug. In the original studies, a large percentage of people had to drop out because they could not tolerate the side-effects. 


Elliot Udell, DPM, Hicksville, NY 



From: Allen Jacobs, DPM


When corporations suggest that one utilize particular codes for reimbursement of goods or services from which they profit, research the appropriateness of such CPT or ICD-10 codes before utilizing them. Remember, the goal of industry is to increase product utilization and profit. The suggestion that topical application of 8% capsaicin qualifies as “destruction of a peripheral nerve” is dubious. We have all too much of code interpretation and manipulation in practice. Slant back nail removal without anesthesia billed as CPT 11730. Arthroereisis billed as “open reduction and internal fixation of a peritalar dislocation,” or “modified subtalar joint arthrodesis”. Radiofrequency coblation billed as “partial plantar fasciotomy”. Lapidus procedures with screw fixation extending into a cuneiform (s) billed as “intertarsal fusion”. 


Recently, one particular company manufacturing hardware for performance of the Lapidus procedure has suggested that with the utilization of their device, a modifier may be added indicating that the procedure should be paid at a higher level due to complexity. Our residents in St. Louis have been given sample operative reports (from a particular company) to dictate so as to justify appending the complexity modifier to the Lapidus procedure. You will be the ones paying back the money on audit, not the corporate entities or the so called thought leaders who are receiving hundreds of thousands of dollars (or more) to encourage you to utilize coding of questionable accuracy. As an example, I would refer PM News readers to the recently published Culper Research Report, November 15, 2022 regarding Treace Medical Concepts.


Allen Jacobs, DPM, St. Louis, MO



From: George Jacobson, DPM


When I first glanced at this post, my brain saw "Commercialization of Medicare." The television commercials for Medicare here in Florida are beyond commercialization; they are fee splitting. If a doctor offered to pay your Medicare premium for coming in, we'd be jailed. Some Medicare Advantage plans now also offer quarterly cash payments for out-of-pocket expenses. The TV commercials are frequently a bait and switch. You call the hotline for one thing and are switched to another. They have always had many additional benefits, but cash payments! If the health insurers get so much money per patient for these Advantage plans, how about reducing the Medicare premium for everyone and pay them less. 


We pay for some of this through our paychecks. Why should we have reductions in our reimbursements, when the payments are bloated to the insurers? Are commercialization and politicization of drugs and healthcare the same thing? My vote is yes. A good example of this is the current Covid vaccine commercials. They most certainly are commercialization, under the guise of being politically correct. 


George Jacobson, DPM, Hollywood, FL



From: Pete Harvey, DPM, Paul Kesselman, DPM


When I dispense an orthotic, it is with the intention of helping the foot, heel, or ankle problem. If the patient returns in a few weeks or months and says their knee or back feels better, I say great. But, I claim no credit.


Pete Harvey, DPM, Wichita Falls, TX


Thank you to Dr. Jacobs for providing the most rational response to this issue. Over the last twenty years, I have performed hundreds, if not thousands, of peer review examinations and/or independent medical exams (IMEs) on no fault cases. In many of these cases, the patient was referred to a podiatrist only because the patient was in a car accident. There was no distal leg/ankle/foot pathology or trauma and these are clearly in No-Fault mills, and the patient is simply seen as a cash cow to run the revenue stream up.


The foot examination is typically a joke, with little references to any acceptable objective scopes of examination other than to justify an orthotic. There is a lack of follow-up documentation supporting any...


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



From: Jeff Pinsky, DPM


Like so much of the stuff we see and read on social media, only part of the story gets exposed. I know a few people within Anthem (now Elevance, though still operating under the Anthem brand in many areas) and regardless of pre-authorization, the billing (CPT, HCPCS, ICD, etc.) codes need to be correct and complete to get approved for payment. This didn’t happen in her case.


Also as the TikTok clip stated, we all know that the hospital and doctors did the billing, but the public has little to no insight into how medical billing works, and it’s always fun to blame the “big evil insurers”. Patients shouldn’t have to resort to exposing their medical history on social media to get claims properly...


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



RE: Qutenza (Ronald Carlson, DPM)

From: R. Alex Dellinger, DPM


I believe one must be very careful when billing for this product. Their own billing guide online states: "No existing CPT code is specific to the QUTENZA application." However, their website lists some of the following CPT codes:


64620 Destruction by neurolytic agent, intercostal nerve 

64632 Destruction by neurolytic agent, plantar common digital nerve 

64999 Unlisted procedure, nervous system 

64640 Destruction by neurolytic agent procedures on the somatic nerve


I don't believe billing for one of the above CPT codes after performing a topical application of Capsaicin would be appropriate (except possibly 64999). And to do this three times? So, the first two times weren't "destructive"? I found a billing and coding article from CGS Region J15 Part B regarding Qutenza: My advice is "provider beware".  


R. Alex Dellinger, DPM, Little Rock, AR



From:  Ivar E. Roth DPM, MPH


With all my patients I always include a question if they have any back problems. For those patients, I almost always recommend orthotics. Most all who get them are very satisfied and I would say 25% of the patients coming in with back pain order the orthotics. I think all podiatrists should do this. You would be surprised how many patients you can help.


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



From: R. Alex Dellinger, DPM


I had the same issue. On a whim, I called a compounding pharmacist I know at Cornerstone Pharmacy in Little Rock, AR and provided her the ingredient list. I gave her the package insert for Cantharone plus and she was able to compound the near exact formulation (I think there is 1% difference in the canthiridin percentage). She provides it in 10 mL vials, with a glass stick in the cap. It works exactly the same as Cantharone Plus (as you would expect). It was even cheaper than what I was buying from the Canadian pharmacy.


R. Alex Dellinger, DPM, Little Rock, AR



RE: Book Review: Dr. Richard Blake’s Practical Biomechanics for the Podiatrist, Book 2

From: Kevin A. Kirby, DPM


Richard L. Blake, DPM, MS has just published his second book in his four-book series on the subject of Practical Biomechanics for the Podiatrist. In this 327-page hardback book with over 350 color  photos, Dr. Blake has compiled one of the most complete books, to date, on the science and art of treating patients with biomechanically-related foot and lower extremity pathologies.


The book starts with the chapter on “Basic Components of a Lower Extremity Examination” where Dr. Blake reviews the examination concepts recommended by Dr. Merton Root and colleagues from...


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



From: Wenjay Sung, DPM


I agree with Dr. Sherman wholeheartedly that it is time that one board finally offers both pathways in our profession. Although Dr. Rogers’ gambit with CAQ may not be in the future, it puts the onus on APMA to allow the boards to create a single pathway for medicine and surgery. It is high time to allow ABFAS to create a certification pathway in podiatric foot and ankle medicine and ABPM to create one in podiatric foot and ankle surgery. There are no laws against the boards to compete like this except it may disrupt the "Podiatry Lives Matter" gatekeepers.


Wenjay Sung, DPM, Los Angeles, CA



From: Jay Seidel, DPM, Edwin S. Hart III, DPM


I have been using On Time Medical Billing Solutions for the past 3 years. They are responsive, competent, fairly priced, and aggressive with collecting my reimbursements. I highly recommend it.


Jay Seidel, DPM,  Deerfield Beach, FL 


I have been using Mediclaim, Inc. from Philadelphia with great success. Rates are very good and the owner Mark Liddy is the one to contact. With overhead increasing and no increase in reimbursement, it makes sense to outsource billing these days.


Edwin S. Hart III, DPM, Bethlehem, PA



From: Jon Purdy, DPM


Board certification, in this day and age, is a requirement to maintain insurance contracts and hospital privileges in almost all cases. Unlike days past, when certification was a badge of honor and optional, today, not becoming board certified can mean the end of a physician's practice. Like any political world, our profession is intertwined among our state, the APMA, and multiple certification boards. To challenge this, especially on a state society level, is a political hot potato. Even individuals appear to be fearful in using their names in posting commentary. The APMA, through the HOD, in conjunction with the CPME, gives the green light to the boards of their choosing. It then follows that states will transfer this decision to their individual licensing boards, and therefore the acceptance of hospitals and insurance companies.


Knowing the severity of not becoming certified should make one question the fairness and oversight in the administration of such a certification board. One should know that the ABFAS (American Board of Foot and Ankle Surgery) and the ABPM (American Board of Podiatric Medicine) have "self-certified," and do not currently have any standardized third-party accreditation or ....


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

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