From: R. Alex Dellinger, DPM
This scenario has happened to us before, not from Regence, but by another company. It was the same thing: send the records to CIOX. When we challenged it, they said, "you are under contract." I politely asked for a copy of the contract, and they sent one - but it was a blank contract! It was neither signed by any insurance company representative or anyone from our group.
The contract DID state providers are obligated to provide chart note upon request for any reason. I responded by stating that we will provide any information that we are contractually obligated to do, but if they wanted the information requested, they needed to pay our per chart charge. They eventually did, and we sent them the requested charts. Oh, the games they play.
R. Alex Dellinger, DPM, Little Rock, AR
10/20/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: We Need New Leadership and a New Direction
From: Ross B. Feinman, DPM
Unfortunately, in the last five years, the talent coming out of the podiatry schools is dismal at best! It's time that the schools either be consolidated and half of them closed, or let the MD or DO schools take them over. For far too long, these schools have been run as a business rather than a beacon of higher education. There are too many schools and the students who are coming to the hospitals and rotating are sadly not qualified to work at a sub shop. There are a few exceptions; some of the students that I have had the chance to work with have shown some aptitude, some eagerness to learn, but for the most part, they're looking at their phones the whole time waiting to get done, lack preparation before any cases, and complain that they haven't eaten lunch yet!
The profession is at a crucial time right now. If something doesn't change soon, orthopedists and PAs are going to overtake our profession. In the past, we heard all these ramblings of ortho and nurse practitioners. We weren't as concerned at the time because we were the most qualified to treat the foot and ankle, but if you take a look at the graduates coming out, I can't blame patients if they want to seek other practitioners! It's the 4th quarter and we're down a lot of points with time running out. We need new leadership and a new direction, or all the hard and innovative work of the past will crumble like a house of cards.
Ross B. Feinman, DPM, Walled Lake, MI
10/16/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Ivar E. Roth DPM, MPH
I have mentioned this before; the reason for the low student retention numbers of the matriculating classes in general is that the schools basically are allowing everyone in, and if the student can pass, they move on and, if not, they drop out. It really is that simple.
Ivar E. Roth DPM, MPH, Newport Beach, CA
10/15/2025
RESPONSES/COMMENTS (THE FUTURE OF PODI;ATRY)
From: Bob Smith, DPM
I do appreciate the student data centered on enrollment and graduation rates recently made available in PM News. I have read this central theme presented throughout the year from assertions and responses. This dialog has peaked my curiosity. I do agree that new residency programs should be approved by ACGME because, in my opinion and research, the subject of pain management and substance use disorder can be taught uniformly across all healthcare disciplines.
Furthermore, I am interested in the numbers of graduation rates and reasons for not completing the college’s programs, and speculate that perhaps students transferred to other podiatry colleges. Moreover, the cost and student loan burden has always puzzled me among healthcare professionals. I believe the need is so dire for all healthcare professionals, especially podiatrists, in preventing lower extremity amputations, falls, and lower extremity pain associated with chronic disease that communities, states, and federal governments should subsidize medical education to fill the obvious chasm. Perhaps the colleges can provide tuition costs and student loan data for each of their classes, and we as a profession may offer solutions to mitigate this burden.
Bob Smith, DPM, Ormond Beach, FL
10/15/2025
RESPONSES/COMMENTS (YOU CAN'T MAKE THESE THINGS UP)
RE: Outrageous Shoe of the Day
From: Richard M. Cowin, DPM
How about calling this a SHOEfar?
Richard M. Cowin, DPM, Orlando, FL
10/14/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Obituary for the DPM Degree
From: Rod Tomczak, DPM, MD, EdD
The obituary can now be completed and a necrology constructed. It’s time to sit Shiva, recite the Kaddish, and assemble the musicians for Mozart’s Requiem. The mourning is not for podiatry, it is too strong, stronger than the 70 or 80 years of Psalm 90. The mourning is for the DPM degree. Podiatry is a philosophy much stronger than three initials and will continue to be with us for a long time.
But what we have learned in the last months is that the youth opting for our profession want a plenary license, not the parochial one we have possessed and have thrived under. They want a seat at the adult medical table. How do we know this? Eighty-seven percent (87%) of the podiatrists who answered the survey in PM News stated concerning a professional degree they wanted the option of having a DO degree to practice podiatry or at least have the option of choosing podiatry as physicians with a DO degree. Only 13% said...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
10/14/2025
RESPONSES/COMMENTS (PM EDITORIALS)
From: Hal Ornstein, DPM
The Power of Presence delivered such powerful messages. Many have lost the art of medicine, and this editorial hit many important things on the head. It would be great to get this in the hands of students and residents.
Hal Ornstein, DPM, Howell, NJ
10/13/2025
RESPONSES/COMMENTS (CLINICAL PEARLS)
RE: Foreign Body Prevention Tip
From: Jeffrey Klirsfeld, DPM
We all treat kids and adults who spend time on turf. An addition to treating them is looking inside their shoes for the granules or crum rubber that gets inside all the time. I just removed an encapsulated foreign body from a referee's foot who is always on the turf. A suggestion would be for them to vacuum their shoes daily.
Jeffrey Klirsfeld, DPM, Levittown, NY
10/13/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Medicare Shutdown and Cash Flow
Right now, cash practices are in good shape. Medicare is shut down. We know it’s temporary, but it impacts any practice with low cash flow.
Steven Finer, DPM, Philadelphia, PA
10/10/2025
RESPONSES/COMMENTS (AMPUTATION PREVENTION)
From: Martin R. Taubman, DPM, MBA
Here’s another use for a wire marker with an x-ray: Use a tiny lead ball (a tiny piece broken off a paperclip will also work) and paper-tape it to the foot or toe to mark a plantar keratoma, a dorsal or lateral toe “corn,” or a heloma molle. Patients are more likely to clearly understand the etiology of the lesion, and are more amenable to various treatments, such as shoe changes, debridement, padding, or surgery.
Martin R. Taubman, DPM, MBA (Retired), San Diego, CA
10/09/2025
RESPONSES/COMMENTS (AMPUTATION PREVENTION)
From: Joel Lang, DPM
As a follow-up to this old but good lipstick idea, I used my x-ray to confirm that the orthotic corrections were in the right place.
I would place a "thin" loop of bare wire on the patient's foot at the location of the vulnerable part. I would place a "thicker" bare wire on the orthotic indicating the location of the correction to protect that part. Both were held in place temporarily with Scotch tape, available at any home improvement store.
I would then take a DP x-ray of the patient's foot in the shoe to see that the two wires coincide. Using different thicknesses of wire made it easy to differentiate which wire was on the foot and which was on the orthotic.
Joel Lang, DPM, Cheverly, MD (retired)
10/08/2025
RESPONSES/COMMENTS (RELEVANT RESEARCH)
From: George R Vito, DPM
I think the profession of foot and ankle surgeons has learned a lot over the past 30 years in reference to Charcot reconstruction. I was with Drs. McGlamry and Banks when we first started performing reconstructions with a two-team approach; the surgery lasted 8 hours, with Dr. McGlamry taking the first four-hour shift, with Dr. Banks on the second 4-hour shift. Needless to say, this may not have been the best approach, but then again, who knew what the best approach was. Then we dove into the external frame game. This my friends, started in 1993, when the first ring fixator was placed on the foot and ankle in Macon, Georgia, not in Tucker GA. I taught the leaders in the profession, i.e., Drs. Kalish, Laporta, Jimenez, Hutchinson, Schuberth, who in turn taught their residents, and in turn, their residents, which has been about 33 years in the process.
We all tried every different way to deal with the Charcot foot and ankle. From waiting to full consolidation to performing surgery as soon as...
Editor's note: Dr. Vito's extended-length letter can be read here.
10/07/2025
RESPONSES/COMMENTS (RELEVANT RESEARCH)
RE: Charcot Reconstruction Articles Should Have Good Long-Term Follow-Up
From: Steven Kravitz, DPM
A review of the literature suggests that Charcot reconstruction has a high rate of revisional surgery. In spite of the fact that surgical skills can provide very good immediate post-operative results on radiographs, etc., the fact remains that the disease process is ongoing. Recurring inflammatory changes associated with osteoclastic activity can compromise an otherwise good post-operative result.
Long-term follow-up of several years following reconstructive surgery is best included in Charcot-related pathology. Further reading on this and other subjects can be found in multiple publications including International Orthopedics 2022 and 2023.
Steven Kravitz, DPM, Winston-Salem area, NC
10/07/2025
RESPONSES/COMMENTS (AMPUTATION PREVENTION)
RE: Has Podiatry Forgotten How to Save Limbs and Lives Using Lipstick?
From: Lawrence Rubin, DPM
Amid the advanced technologies in wound care, a simple, low-tech method involving lipstick and felt highlights a powerful approach to prevent diabetic foot ulcers and amputations. This technique showcases that effective preventative care often relies on smart, simple, and systematic practices.
An elegant solution for pressure relief:
In the diabetic foot, high pressure on the skin — especially around the metatarsophalangeal joints at the sole of the foot—can cause tissue damage and eventually lead to an ulcer. The "lipstick" method offers a straightforward way to identify and relieve this pressure:
Mark the spot: A podiatrist or other wound care clinician places a dab of lipstick on...
Editor's note: Dr. Rubin's extended-length letter can be read here.
10/06/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Decreasing Malpractice Risk Using a Team Approach
Steven Kravitz, DPM
There has been a lot of literature regarding techniques to avoid malpractice suits. One aspect I do not find discussed as much is selection of patients and not being afraid to reter patients elsewhere when staff or the physician is not comfortable selecting the patient as a surgical candidate.
This includes collaborating closely with a good staff who can also identify aspects of a particular patient that the physician may not identify. Staff may have more time to discuss different aspects and pick up nuances with the patient that the doctor may not have seen. In short, reducing risk by selecting patients is a team approach with physician and staff working closely together to best select patients that they believe are good surgical candidates and will decrease risk of a lawsuit.
Different people have different personalities but that does not mean the patient has to be the doctor's best friend, but it does mean that you, as the physician involved, and the patient must feel comfortable working with each other before you take the knife to the patient.
Steven Kravitz, DPM, Winston-Salem N.C. area
10/02/2025
RESPONSES/COMMENTS (OBITUARIES)
RE: The Passing of Andrew Lindekugel, DPM
We are heartbroken to share that Benefis podiatric surgeon Dr. Andrew Lindekugel, 45, has passed away unexpectedly after a struggle with depression. He was loved by his patients and colleagues at Benefis, and our hearts go out to everyone who cared about him. He will be so missed.
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Dr. Andrew Lindekugel |
Dr. Lindekugel improved the mobility - and lives - of many patients at the Benefis Foot and Ankle Clinic of Montana. He joined Benefis in 2020 and was part of our community since 2017, specializing in podiatric surgery, peripheral nerve repair, clubfoot correction, and wound care with more than 15,000 visits during his time here.
Source: Benefis Health System [9/25/25]
10/01/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Steve Tager, DPM
While I agree wholeheartedly with Dr. Kornfeld's and Dr. Tager's advice, one VERY important point is mostly missed when recommending a change to a direct pay or cash basis model of practice: just like in the real estate business, it is about location, location, location.
Narmo L. Ortiz, Jr., DPM, Davenport, FL.
09/30/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Steve Tager, DPM
I tell this story with the sole purpose of helping those in the profession who are fed up with the current nonsense and mental gymnastics required to sustain the traditional and current model solo or group podiatry practice today. And more so, the uncertainty on the horizon.
For reference, starting solo practice in 1966 after a short stint in a terribly busy practice (60 patient/day; 40 to me and 20 to the owner), I quickly learned a bit about private practice and its management. So, without hesitation and extremely limited business experience, in the winter of 66 I opened my practice in a medical building in Cranston, RI. After 16 years experiencing ridiculously low reimbursement from RI BCBS, a move to Northern CA made sense for a variety of...
Editor's note: Dr. Tager's extended-length letter can be read here.
09/30/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1
From: Robert Scott Steinberg, DPM
This is why AI must be carefully fact-checked!
Dr. Rubin omitted the most critical action that propelled our profession forward in Illinois, namely the two-month student strike at the Illinois College of Podiatric Medicine in the early 1970s. Dr. Scholl was not relevant to that action.
Robert Scott Steinberg, DPM, Schaumburg, IL.
09/30/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 2
From: Rod Tomczak, DPM, MD, EdD
Dr. Bisbee, there are a few individuals one should never try to mislead. First is your lawyer about your actions, second is your clergyman about the state of your soul, and the third is Rod Tomczak about medical educational matters, especially podiatric medical education.
In 2020, five years ago, AAOS, ACFAS, AOFAS and the APMA endorsed a four point plan in a White Paper titled “Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Enabling Them to Take the USMLE.”
Point three of the four reads, CPME approval of podiatric residency programs should meet comparable standards to Accreditation Council for Graduate Medical Education (ACGME). APMA agreed to this. I call renege. ACGME cannot testify to the equality of podiatry residencies to say, ...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/29/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: Three Cheers for Dr. Scholl?
From: Lawrence Rubin, DPM (AI Augmented)
I think that for most "old timer" DPMs like me, when we hear, the name "Dr. Scholl" mentioned, this evokes memories of pharmacy aisles filled with cushioned insoles and foot care products. But behind this familiar brand was a genuine visionary, William Mathias Scholl, whose contributions to the profession of podiatry extend far beyond simple arch supports. His timeless lessons in education, public awareness, and the marriage of technology with expert care hold a key to podiatry's future, offering a blueprint for navigating a rapidly evolving healthcare landscape.
A Legacy of Learned Care: When William Scholl founded the Illinois College of Chiropody and Orthopedics in 1912 (Later the Illinois College of Chiropody and Foot Surgery, and now the Scholl College of Podiatric Medicine.), foot care was often considered a trade, not a medical science. By creating a curriculum that mirrored allopathic medicine, Scholl elevated the field, mandating that his students receive a rigorous education in...
Editor's note: Dr. Rubin's AI Augmented extended-length letter can be read here.
09/29/2025
RESPONSES/COMMENTS (VALUE-BASED CARE)
From: Elliot Udell, DPM
Although many of us have disagreed with Drs. Kornfeld and Roth with regard to not accepting insurance as payment for our services, the times we live in might cause us to rethink our disagreements. I recently had cataract surgery. The doctors agreed to accept insurance for the removal of the cataract, but in order to use their laser machine to make and close the incisions and correct astigmatism, I had to cough up two thousand dollars, cash.
The bottom line is that this prominent and well-respected eye care center was not willing to give up taking insurance totally, but they found a good way to supplement their income by charging an out-of-pocket fee for part of the procedure. Perhaps Drs. Kornfeld and Roth can suggest ways in which podiatrists could accept insurance for certain services and charge out-of-pocket for others.
Elliot Udell, DPM, Hicksville, NY
09/29/2025
RESPONSES/COMMENTS (MEDICARE PART C AUDITS)
RE: Risk Assessment Audits for Part C Plans
From: Paul Kesselman, DPM
As expected, CMS has clamped down on their auditing of risk assessments performed on Part C plans. It remains unclear at this time whether this will change the burden on providers, as Part C plans continue to require network providers to cooperate and submit charts for review.
In reviewing this multi-page document (a snoozer), it appears that carriers will have a narrower number of diagnoses to report per patient chart (reduced from 5 to 2). Does this necessarily change how many patient chart requests specialists will be targeted for, or increase the risks for the family internist? For more information click here.
In other news, Becker’s reports that the a court decision in Texas ruled in favor of Humana. This decision removed almost 17% of Humana’s earnings ($900M) from potential risk assessment audits. Despite this setback (mostly based on a lack of proper notification and procedural), CMS continues to advocate that it will continue to aggressively pursue risk assessment audits of Medicare Part C plans.
Paul Kesselman, DPM, Oceanside NY
09/27/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: A Short Allegory Chapter 2
From: Rod Tomczak, DPM, MD, EdD
Steve Winans was the de facto leader of the unofficial group that sat around the pot belly stoves at the seed store dropping peanuts in their Cokes or Dr. Peppers. He was up every morning before dawn and worked tirelessly all day. He found work where there wasn’t any work. He learned these characteristics from his dad who was the same way. The thing about Steve was that he had more than a touch of big city in him, something the other farmers didn’t have, and he saw things in a way the other farmers of Agronomy’s Best (AB) didn’t see them. If he hadn’t been born and raised in AB, you would have sworn he was placed in AB, Iowa by Witness Protection. He was the only guy who could tell you how to sink a large yacht in the middle of Iowa.
Greg Samsa, on the other hand, very smooth in his hand tailored suits and ostrich non-work boots was the elected chairman of the Agronomy’s Best Fine Arts Commission, (ABFAC) by the other members of the Commission. They did make all the important decisions for AB. The population of AB didn’t want to be...
Editor's note: Dr. Tomczak's extended-length letter can be read here. Chapter 1 can be read here.
